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Moran VH, Ceballos-Rasgado M, Fatima S, Mahboob U, Ahmad S, McKeown M, Zaman M. Participatory action research to co-design a culturally appropriate COVID-19 risk communication and community engagement strategy in rural Pakistan. Front Public Health 2023; 11:1160964. [PMID: 37168074 PMCID: PMC10166109 DOI: 10.3389/fpubh.2023.1160964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
Background Community engagement has shown to be fundamental component of the response to previous disease outbreaks. This study aimed co-design and implement a culturally appropriate COVID-19 risk communication and community engagement strategy with a resource-poor rural community in Northwest Pakistan. Methods Participatory Action Research (PAR) was conducted from January 2021 to March 2022. Five PAR meetings took place with community members (n = 30) to: (1) explore how the COVID-19 pandemic impacted on the community; (2) identify challenges to limit the spread of the virus; (3) identify and implement solutions to these challenges; and (4) highlight the enablers, challenges and knowledge of the cultural context needed to optimize safety during emergencies. Focus group discussions (N = 6) with community members not involved in the PAR meetings (N = 50) and children of the community (N = 26) were conducted following the PAR meetings. Thematic analysis of the PAR and focus group data was conducted. Results Delivery of messages on how to keep families safe, provision of personal protective equipment and improved water systems were part of the strategies taken by the community to create awareness and reduce the spread of COVID-19. Nine themes were identified: Attitudes to the pandemic: From skepticism to acceptance, Changing attitudes about vaccination: rumors and trust, COVID-19 and Faith, Social impact of the pandemic, Access to water, Resource mobilization: personal protective equipment, Spaces where collaborative effort can bring to solutions, Agents of change, and Empowerment of women. Discussion The participatory approach of this research allowed understanding of the challenges faced by the community to engage in behavior change strategies to reduce the spread of COVID-19 and enabled the community to find sustainable solutions. Engagement with the community empowered men and women to be agents of change and promoted necessary precautionary actions to reduce the risk of infection within their community. Conclusion Participatory approach highlighted the importance of engaging with and integrating to local culture and values to overcome challenges such as gender imbalance and distrust. Findings of this study are relevant to others working in diverse cultural settings in similar crises events regardless of particular cultural variations.
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Affiliation(s)
- Victoria Hall Moran
- Centre for Global Development, University of Central Lancashire, Preston, United Kingdom
| | | | - Sadia Fatima
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
- *Correspondence: Sadia Fatima,
| | - Usman Mahboob
- Institute of Health Professions Education and Research, Khyber Medical University, Peshawar, Pakistan
| | - Salman Ahmad
- Department of Sociology, Abdul Wali Khan University, Mardan, Pakistan
| | - Michael McKeown
- School of Nursing, University of Central Lancashire, Preston, United Kingdom
| | - Mukhtiar Zaman
- Department of Pulmonology, Rehman Medical Institute, Peshawar, Pakistan
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Kabue M, Abubakar A, Ssewanyana D, Angwenyi V, Marangu J, Njoroge E, Ombech E, Mokaya MM, Obulemire EK, Mugo C, Malti T, Moran G, Martin MC, Proulx K, Marfo K, Zhang L, Lye S. A community engagement approach for an integrated early childhood development intervention: a case study of an urban informal settlement with Kenyans and embedded refugees. BMC Public Health 2022; 22:711. [PMID: 35410147 PMCID: PMC8995906 DOI: 10.1186/s12889-022-13185-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community engagement is crucial for the design and implementation of community-based early childhood development (ECD) programmes. This paper aims to share key components and learnings of a community engagement process for an integrated ECD intervention. The lessons shared are drawn from a case study of urban informal settlement with embedded refugees in Nairobi, Kenya. METHODS We conducted three stakeholder meetings with representatives from the Ministry of Health at County and Sub-County, actors in the ECD sector, and United Nations agency in refugee management, a transect walk across five villages (Ngando, Muslim, Congo, Riruta and Kivumbini); and, six debrief meetings by staff from the implementing organization. The specific steps and key activities undertaken, the challenges faced and benefits accrued from the community engagement process are highlighted drawing from the implementation team's perspective. RESULTS Context relevant, well-planned community engagement approaches can be integrated into the five broad components of stakeholder engagement, formative research, identification of local resources, integration into local lives, and shared control/leadership with the local community. These can yield meaningful stakeholder buy-in, community support and trust, which are crucial for enabling ECD programme sustainability. CONCLUSION Our experiences underscore that intervention research on ECD programmes in urban informal settlements requires a well-planned and custom-tailored community engagement model that is sensitive to the needs of each sub-group within the community to avoid unintentionally leaving anyone out.
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Affiliation(s)
- Margaret Kabue
- Institute for Human Development, Aga Khan University, Nairobi, Kenya.
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Derrick Ssewanyana
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - Vibian Angwenyi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Joyce Marangu
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Eunice Njoroge
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Eunice Ombech
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | | | | | - Catherine Mugo
- Ministry of Health-Kenya, Nairobi Metropolitan Services, Dagoretti Sub-county, Nairobi, Kenya
| | - Tina Malti
- Centre for Child Development, Mental Health, and Policy, University of Toronto Mississauga, Toronto, Canada.,Department of Psychology University of Toronto, Toronto, Canada
| | - Greg Moran
- Academics without Borders, Toronto, Canada
| | - Marie-Claude Martin
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - Kerrie Proulx
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - Kofi Marfo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Linlin Zhang
- School of Psychology, Capital Normal University, Beijing, China
| | - Stephen Lye
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
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Corbin JH, Oyene UE, Manoncourt E, Onya H, Kwamboka M, Amuyunzu-Nyamongo M, Sørensen K, Mweemba O, Barry MM, Munodawafa D, Bayugo YV, Huda Q, Moran T, Omoleke SA, Spencer-Walters D, Van den Broucke S. A health promotion approach to emergency management: effective community engagement strategies from five cases. Health Promot Int 2021; 36:i24-i38. [PMID: 34897448 PMCID: PMC8667549 DOI: 10.1093/heapro/daab152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Community engagement is crucial for controlling disease outbreak and mitigating natural and industrial disasters. The COVID-19 pandemic has reconfirmed the need to elevate community engagement to build equity, trust and sustained action in future health promotion preparedness strategies. Using the health promotion strategy of strengthening community action enhances the opportunity for better outcomes. There is, therefore, a need to improve our understanding of community engagement practices during crises, scale-up good community engagement initiatives, and improve and sustain people-centered approaches to emergency responses. This paper presents five case studies from the United States, Singapore, Sierra Leone, Kenya and South Africa that demonstrate the potential strengths that can be nurtured to build resilience in local communities to help mitigate the impact of disasters and emergencies. The case studies highlight the importance of co-developing relevant education and communication strategies, amplifying the role of community leaders, empowering community members to achieve shared goals, assessing and adapting to changing contexts, pre-planning and readiness for future emergencies and acknowledgement of historic context.
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Affiliation(s)
- J Hope Corbin
- Department of Health and Community Studies, Western Washington University, Bellingham, WA, USA
| | - Ukam Ebe Oyene
- Country Readiness Strengthening Department, WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Erma Manoncourt
- School of Global Public Health, New York University, New York, NY, USA
- Paris School of International Affairs, Sciences Po, Paris, France
| | - Hans Onya
- Department of Public Health, University of Limpopo, Sovenga, South Africa
| | | | | | | | - Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Margaret M Barry
- World Health Organization Collaborating Centre for Health Promotion Research, School of Health Sciences, National University of Ireland, Galway, Ireland
| | - Davison Munodawafa
- Department of Community Medicine, Faculty of Medicine, Midlands State University, Gweru, Zimbabwe
- Global Health, Thammasat University, Bangkok, Thailand
| | - Yolanda V Bayugo
- Country Readiness Strengthening Department , WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Qudsia Huda
- Health Security and Preparedness Department, WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Tomas Moran
- Global Infectious Hazards Preparedness Department, WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Dayo Spencer-Walters
- Country Readiness Strengthening Department , WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Stephan Van den Broucke
- Faculté de Psychologie et des Sciences de l'Education, Institut de Recherche en Sciences Psychologiques, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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Mahboob U, Ohly H, Joy EJM, Moran V, Zaman M, Lowe NM. Exploring community perceptions in preparation for a randomised controlled trial of biofortified flour in Pakistan. Pilot Feasibility Stud 2020; 6:117. [PMID: 32821423 PMCID: PMC7433115 DOI: 10.1186/s40814-020-00664-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Biofortification of staple food crops may be a cost-effective and sustainable approach to reducing micronutrient deficiencies in resource-poor settings with low dietary diversity. However, its success depends on uptake by the local population. This paper presents formative research conducted in a remote, rural community in North West Pakistan, prior to commencing a randomised controlled trial to test the effectiveness of consuming zinc-biofortified wheat flour for alleviating zinc deficiency. It explored local community members’ knowledge, understanding and attitudes towards biofortification and views on members of their community taking part in the trial. Methods Four focus group discussions were conducted with male and female community members (separately for cultural reasons) and four in-depth interviews were conducted with Jirga members—respected male elders. Participation was limited to households that were ineligible for the trial so that we could explore the perspectives of community members who were not influenced by the incentives of the trial. Focus group participants were selected at community events for transparency. Data collection took place at the local school and homes of Jirga members. Thematic analysis was undertaken, using a combination of deductive and inductive approaches to identify key themes. Results A total of 47 men and women participated in this study. Participants reported clear motivation to access and consume more nutritious flour, believing this would bring health benefits, particularly to women and children. Trusted members of the local community, including Jirga members and female health workers, should be involved in providing information on biofortified flour (and the trial) to increase levels of awareness and acceptance. Without their involvement, there is a risk that biofortified flour would be mistrusted. The cost of flour is the main factor affecting purchasing decisions, and biofortified flour will need to be cost-competitive to achieve widespread uptake in marginalised, rural communities. Conclusion This formative study generated rich, qualitative data from a range of community stakeholders to improve the understanding of important barriers and facilitators to the widespread acceptability and adoption of biofortified wheat. Implementation research such as this will inform future decision-making in relation to scaling up biofortified wheat in Pakistan.
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Affiliation(s)
- Usman Mahboob
- Khyber Medical University, Phase V, Hayatabad, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Heather Ohly
- University of Central Lancashire, Preston, Lancashire PR1 2HE UK
| | - Edward J M Joy
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Victoria Moran
- University of Central Lancashire, Preston, Lancashire PR1 2HE UK
| | - Mukhtiar Zaman
- Rehman Medical College, 5-B/2, Phase-V, Hayatabad, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Nicola M Lowe
- University of Central Lancashire, Preston, Lancashire PR1 2HE UK
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