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Redvers N, Odugleh-Kolev A, Paula Cordero J, Zerwas F, Zitoun NM, Kamalabadi YM, Stevens A, Nagasivam A, Cheh P, Callon E, Aparicio-Reyes K, Kubota S. Relational community engagement within health interventions at varied outcome scales. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003193. [PMID: 38861576 PMCID: PMC11166349 DOI: 10.1371/journal.pgph.0003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Relational community engagement may be a powerful approach with multiple health outcomes. Relational community engagement has the potential to promote health and involves collaborative efforts between multiple stakeholders. The COVID-19 pandemic further highlighted the centrality of community engagement in health crises. Challenges continue to persist, however, in genuinely engaging and empowering communities for better health outcomes. Understanding the multi-level and complex relational nature of community engagement is essential to comprehend its influence on health at micro, meso, and macro scales of influence. The purpose of this narrative review was to synthesize the literature on relational community engagement within varied health interventions at the three major system levels (micro, meso, and macro) to support the development of future research agendas. At the micro level, relational community engagement interventions demonstrated a range of positive outcomes including: increased sense of control, satisfaction, positive behavior, improved knowledge, behavior change, empowerment, and overall positive health and social outcomes. At the meso level, relational community engagement interventions resulted in increased trust between stakeholders and groups/teams, and increased community senses of ownership of interventions, decisions, structures. At the macro level, relational community engagement interventions influenced broader societal factors and had positive impacts on health policy and governance including collaboration between sectors and communities as well as increased access to services. The review highlights the potential versatility and effectiveness of interventions that prioritize relationships, health promotion, and social change while underscoring the significance of holistic and community-centered approaches in addressing diverse health and social challenges.
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Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Asiya Odugleh-Kolev
- Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Joanna Paula Cordero
- Health Promotion and Social Determinants of Health Unit (HPD), World Health Organization African Regional Office, Brazzaville, Republic of the Congo
| | - Felicia Zerwas
- Department of Psychology, New York University, New York, New York, United States of America
| | - Natalie Mariam Zitoun
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | | | - Amy Stevens
- School of Public Health, Yorkshire and the Humber Postgraduate Deanery, Leeds, United Kingdom
| | - Ahimza Nagasivam
- School of Public Health, Health Education England, London, United Kingdom
| | - Paul Cheh
- The Equity Initiative, China Medical Board Foundation, Bangkok, Thailand
| | - Emma Callon
- Division of Healthy Environments and Populations, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | | | - Shogo Kubota
- Maternal Child Health and Quality Safety, World Health Organization Western Pacific Regional Office, Manila, Philippines
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Ean M, Tripura R, Sothea P, Savoeun U, Peto TJ, Bunthynn S, Callery JJ, Soviet U, Dysoley L, Yeong Cheah P, Adhikari B. A youth advisory group on health and health research in rural Cambodia. Glob Bioeth 2024; 35:2361968. [PMID: 38859929 PMCID: PMC11164040 DOI: 10.1080/11287462.2024.2361968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open
Abstract
Engaging young people in health research has been promoted globally. We explored the outcomes of youth advisory group on health and research engagement (YAGHRE) in rural Cambodia. In May 2021, the Mahidol Oxford Tropical Medicine Research Unit (MORU) partnered with a local health centre and a secondary school to establish a youth engagement group. Ten students underwent training and led health engagement activities in schools and communities. Activities were documented as field notes and audio-visual materials which underwent content analysis using theory of change supplemented by iterative discussions with YAGHRE members and stakeholders. Five major outcomes were identified: 1. Increased respect. Engagement activities developed based on input from students and stakeholders may have fostered greater respect. 2. Built trust and relationships. Frequent visits to MORU's laboratory and interactions with researchers appeared to contribute to the building of trust and relationship. 3. Improved health and research literacy. Learning new health and research topics, through participatory activities may have improved literacy; 4. Improved uptake of health and research interventions. Health promotional activities and communication with research participants potentially increased the uptake of interventions; 5. Improved community health. YAGHRE's health promotional interventions may have contributed in enhancing community's health.
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Affiliation(s)
- Mom Ean
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Phann Sothea
- Techo Siem Pang High School, Provincial Department of Education, Youth and Sport, Siem Pang, Stung Treng, Cambodia
| | - Uch Savoeun
- Siem Pang Health Centre, Provincial Health Department, Siem Pang, Stung Treng, Cambodia
| | - Thomas J. Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Sam Bunthynn
- District Governor Office, Siem Pang District Administration, Siem Pang, Stung Treng, Cambodia
| | - James J. Callery
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Ung Soviet
- Provincial Health Department, Stung Treng, Cambodia
- CNM National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Lek Dysoley
- Provincial Health Department, Stung Treng, Cambodia
- CNM National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Tinner L, Kelly C, Caldwell D, Campbell R. Community mobilisation approaches to preventing adolescent multiple risk behaviour: a realist review. Syst Rev 2024; 13:75. [PMID: 38409098 PMCID: PMC10895861 DOI: 10.1186/s13643-024-02450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Adolescent multiple risk behaviour (MRB) is a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, with systematic reviews reporting mixed evidence of effectiveness. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. There are gaps in the current literature, theory and implementation that would benefit from a realist approach. We use a theory-driven evidence synthesis to assess how and why community mobilisation interventions work/do not work to prevent adolescent MRB and in what contexts. METHODS This realist review used a six-stage iterative process, guided by the RAMESES framework. We systematically searched PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological Abstracts, from their inception to 2021. Studies were screened for relevance to the programme theory, assessed for rigour and included based on a priori criteria. Two independent reviewers selected, screened and extracted data from included studies. A realist logic of analysis was used to develop context-mechanism-outcome configurations that contributed to our programme theory. FINDINGS We reviewed 35 documents describing 22 separate community mobilisation intervention studies. Most studies (n = 17) had a quality assessment score of three or four (out of four). We analysed the studies in relation to three middle range theories. To uphold our theory that these interventions work by creating a social environment where adolescents are less likely to engage in MRB, interventions should: (1) embed a framework of guiding principles throughout the community, (2) establish community readiness with population data and (3) ensure a diverse coalition with the support of intervention champions. Mechanisms such as empowerment through coalition ownership over the delivery of the intervention, cohesion across the community and motivation to work collaboratively to improve adolescent health are triggered to achieve social environment shifts. However, certain contexts (e.g. limited funding) restrict intervention success as these mechanisms are not fired. CONCLUSIONS For community mobilisation interventions to reduce adolescent MRB, the coalitions within them must seek to alter the social environment in which these behaviours occur. Mechanisms including empowerment, cohesion and motivation lead to this shift, but only under certain contexts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020205342.
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Affiliation(s)
- Laura Tinner
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL, UK.
| | - Claire Kelly
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL, UK
| | - Deborah Caldwell
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL, UK
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Klingberg S, Adhikari B, Draper CE, Bosire E, Nyirenda D, Tiigah P, Mukumbang FC. Enhanced or hindered research benefits? A realist review of community engagement and participatory research practices for non-communicable disease prevention in low- and middle-income countries. BMJ Glob Health 2024; 9:e013712. [PMID: 38341191 PMCID: PMC10862340 DOI: 10.1136/bmjgh-2023-013712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Community engagement and participatory research are widely used and considered important for ethical health research and interventions. Based on calls to unpack their complexity and observed biases in their favour, we conducted a realist review with a focus on non-communicable disease prevention. The aim was to generate an understanding of how and why engagement or participatory practices enhance or hinder the benefits of non-communicable disease research and interventions in low- and middle-income countries. METHODS We retroductively formulated theories based on existing literature and realist interviews. After initial searches, preliminary theories and a search strategy were developed. We searched three databases and screened records with a focus on theoretical and empirical relevance. Insights about contexts, strategies, mechanisms and outcomes were extracted and synthesised into six theories. Five realist interviews were conducted to complement literature-based theorising. The final synthesis included 17 quality-appraised articles describing 15 studies. RESULTS We developed six theories explaining how community engagement or participatory research practices either enhance or hinder the benefits of non-communicable disease research or interventions. Benefit-enhancing mechanisms include community members' agency being realised, a shared understanding of the benefits of health promotion, communities feeling empowered, and community members feeling solidarity and unity. Benefit-hindering mechanisms include community members' agency remaining unrealised and participation being driven by financial motives or reputational expectations. CONCLUSION Our review challenges assumptions about community engagement and participatory research being solely beneficial in the context of non-communicable disease prevention in low- and middle-income countries. We present both helpful and harmful pathways through which health and research outcomes are affected. Our practical recommendations relate to maximising benefits and minimising harm by addressing institutional inflexibility and researcher capabilities, managing expectations on research, promoting solidarity in solving public health challenges and sharing decision-making power.
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Affiliation(s)
- Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Edna Bosire
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Deborah Nyirenda
- Community Engagement & Bioethics, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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Dada S, Aivalli P, De Brún A, Barreix M, Chelwa N, Mutunga Z, Vwalika B, Gilmore B. Understanding communication in community engagement for maternal and newborn health programmes in low- and middle-income countries: a realist review. Health Policy Plan 2023; 38:1079-1098. [PMID: 37650702 PMCID: PMC10566325 DOI: 10.1093/heapol/czad078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
As community engagement (CE) is implemented for sustainable maternal and newborn health (MNH) programming, it is important to determine how these approaches work. Low- and middle-income countries (LMICs) have become a particular focus for MNH CE activities due to their high burden of maternal and neonatal deaths. MNH messaging and communication to engage communities are likely to differ by context, but how these approaches are actually developed and implemented within CE is not well understood. Understanding how communications in CE actually work is vital in the translation of learnings across programmes and to inform future projects. The purpose of this realist review is to describe how, why, to what extent and for whom communications in CE contribute to MNH programming in LMICs. After searching academic databases, grey literature and literature suggested by the expert advisory committee, documents were included if they described the CE communication processes/activities used for MNH programming in an LMIC. Relevant documents were assessed for richness (depth of insight) and rigor (trustworthiness and coherence of data/theories). Data were extracted as context-mechanism-outcome configurations (CMOCs) and synthesized into demi-regularities to contribute to theory refinement. After screening 416 records, 45 CMOCs were extracted from 11 documents. This informed five programme theories explaining that communications in CE for an MNH programme work when: communities are actively involved throughout the programme, the messaging and programme are acceptable, communication sources are trusted, the community has a reciprocal relationship with the programme and the community sees value in the programme. While these findings reflect what is often anecdotally known in CE or acknowledged in communications theory, they have implications for policy, practice and research by highlighting the importance of centring the community's needs and priorities throughout the stages of developing and implementing communications for CE in MNH.
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Affiliation(s)
- Sara Dada
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | | | | | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
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Weston S, Adhkari B, Thriemer K. Sharing results with participants (and community) in malaria related research: Perspectives and experience from researchers. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002062. [PMID: 37669255 PMCID: PMC10479888 DOI: 10.1371/journal.pgph.0002062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/06/2023] [Indexed: 09/07/2023]
Abstract
Results-sharing with participants or their communities after the completion of research is an essential element of ethical research. The main objective of this study was to identify and document current practice of trial result dissemination, to explore attitudes among trialists towards result dissemination and to better understand previous experiences and barriers to returning results to participants. This mixed-methods study used a sequential exploratory design with two phases: i) an initial qualitative phase to explore the topic and to inform the quantitative data collection, ii) a quantitative survey. Findings from the survey and interviews were triangulated and presented to a network of clinical malaria researchers for validation. A total of 11 semi-structured interviews (SSIs) were conducted using an interview guide. The quantitative survey had a response rate of 19.9% (42/211). Disseminating results to participants after clinical trials was deemed critical for ethical malaria related research, with 38.1% indicating it as extremely important and 45.2% rating it as mostly important. Most respondents referred to the dissemination of results to policymakers and wider stakeholders as important aspects of research translation. The practice of patient or community engagement was prioritized in the pre-trial period and during the trial for obvious instrumental goals of improving retention, coverage and adherence, but much less priority was given to the post-trial period. The main reason for poor dissemination practice was the notion that the time lag between study participation and the availability of results was too long (42.4%). Other reasons included the assumption that the community was not interested (36.4%), and financial restraints (9.1%). The rich qualitative data revealed detailed accounts of operational, cultural, educational and economic aspects that pose further barriers to results-sharing, including limited knowledge about best practice. Better planning which includes adequate financial resourcing is required for meaningful dissemination of results to study participants. Improved institutional guidance and more stringent requirements by funders could support researchers who are generally interested and willing to complete the process. Best practice methods to conduct such dissemination remains to be explored.
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Affiliation(s)
- Sophie Weston
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Bipin Adhkari
- Mahidol‐Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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Chattopadhyay S, de Kok B. Making research ethics work for global health: towards a more agile and collaborative approach. BMJ Glob Health 2023; 8:e011415. [PMID: 37451687 PMCID: PMC10351231 DOI: 10.1136/bmjgh-2022-011415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/06/2023] [Indexed: 07/18/2023] Open
Abstract
In this reflective essay, we seek to engage in a constructive dialogue with scholars across medicine, public health and anthropology on research ethics practices. Drawing on anthropological research and ethical dilemmas that our colleagues and we encountered as medical anthropologists, we reflect on presumed and institutionalised 'best' practices such as mandatory written informed consent, and problematise how they are implemented in interdisciplinary global health research projects. We demonstrate that mandatory, individualised, written, informed consent may be unsuitable in many contexts and also identify reasons why tensions between professionals in interdisciplinary teams may arise when decisions about ethics procedures are taken. We propose alternatives to written informed consent that acknowledge research governance requirements and contextual realities and leave more room for ethnographic approaches. Beyond informed consent, we also explore the situatedness of ethical practices when working in contexts where decision-making around health is clearly a shared concern. We use vignettes based on our own and colleagues' experiences to illustrate our arguments, using the collective 'we' instead of 'I' in our vignettes to protect our research participants, partners and interlocutors. We propose a decolonial, plural and vernacular approach to informed consent specifically, and research ethics more broadly. We contend that ethics procedures and frameworks need to become more agile, decolonial, pluralised and vernacularised to enable achieving congruence between communities' ideas of social justice and institutional ethics. We argue that global health research can benefit from anthropology's engagement with situated ethics and consent that is relational, negotiated and processual; and accountability that is not only bureaucratic but also constructive. In doing so, we hope to broaden ethical praxis so that the best outcomes that are also just, fair and equitable can be achieved for all stakeholders.
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Affiliation(s)
| | - Bregje de Kok
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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Mthembu Z, Mogaka JJO, Chimbari MJ. Community engagement processes in low- and middle-income countries health research settings: a systematic review of the literature. BMC Health Serv Res 2023; 23:457. [PMID: 37158864 PMCID: PMC10169489 DOI: 10.1186/s12913-023-09466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/27/2023] [Indexed: 05/10/2023] Open
Abstract
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.
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Affiliation(s)
- Zinhle Mthembu
- University of KwaZulu-Natal. College of Health Science, School of Nursing and Public Health, Howard College, 269 Mazisi Kunene Road, Berea, Durban, 4041, South Africa.
- Faculty of Humanities and Social Sciences, Anthropology and Development Studies, University of Zululand, 1 Main Road, Vulindlela, KwaDlangezwa, 3886, South Africa.
| | - John J O Mogaka
- University of KwaZulu-Natal. College of Health Science, School of Nursing and Public Health, Howard College, 269 Mazisi Kunene Road, Berea, Durban, 4041, South Africa
| | - Moses J Chimbari
- University of KwaZulu-Natal. College of Health Science, School of Nursing and Public Health, Howard College, 269 Mazisi Kunene Road, Berea, Durban, 4041, South Africa
- Great Zimbabwe University, Masvingo, P.O. Box 1234, Zimbabwe
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Dada S, Cocoman O, Portela A, De Brún A, Bhattacharyya S, Tunçalp Ö, Jackson D, Gilmore B. What's in a name? Unpacking 'Community Blank' terminology in reproductive, maternal, newborn and child health: a scoping review. BMJ Glob Health 2023; 8:bmjgh-2022-009423. [PMID: 36750272 PMCID: PMC9906186 DOI: 10.1136/bmjgh-2022-009423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/09/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Engaging the community as actors within reproductive, maternal, newborn and child health (RMNCH) programmes (referred to as 'community blank') has seen increased implementation in recent years. While evidence suggests these approaches are effective, terminology (such as 'community engagement,' 'community participation,' 'community mobilisation,' and 'social accountability') is often used interchangeably across published literature, contributing to a lack of conceptual clarity in practice. The purpose of this review was to describe and clarify varying uses of these terms in the literature by documenting what authors and implementers report they are doing when they use these terms. METHODS Seven academic databases (PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, Global Health), two grey literature databases (OAIster, OpenGrey) and relevant organisation websites were searched for documents that described 'community blank' terms in RMNCH interventions. Eligibility criteria included being published between 1975 and 1 October 2021 and reports or studies detailing the activities used in 'community blank.' RESULTS: A total of 9779 unique documents were retrieved and screened, with 173 included for analysis. Twenty-four distinct 'community blank' terms were used across the documents, falling into 11 broader terms. Use of these terms was distributed across time and all six WHO regions, with 'community mobilisation', 'community engagement' and 'community participation' being the most frequently used terms. While 48 unique activities were described, only 25 activities were mentioned more than twice and 19 of these were attributed to at least three different 'community blank' terms. CONCLUSION Across the literature, there is inconsistency in the usage of 'community blank' terms for RMNCH. There is an observed interchangeable use of terms and a lack of descriptions of these terms provided in the literature. There is a need for RMNCH researchers and practitioners to clarify the descriptions reported and improve the documentation of 'community blank' implementation. This can contribute to a better sharing of learning within and across communities and to bringing evidence-based practices to scale. Efforts to improve reporting can be supported with the use of standardised monitoring and evaluation processes and indicators. Therefore, it is recommended that future research endeavours clarify the operational definitions of 'community blank' and improve the documentation of its implementation.
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Affiliation(s)
- Sara Dada
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland .,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Olive Cocoman
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Debra Jackson
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Brynne Gilmore
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Dada S, De Brún A, Banda EN, Bhattacharya S, Mutunga Z, Gilmore B. A realist review protocol on communications for community engagement in maternal and newborn health programmes in low- and middle-income countries. Syst Rev 2022; 11:201. [PMID: 36096841 PMCID: PMC9465973 DOI: 10.1186/s13643-022-02061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community engagement (CE) has been increasingly implemented across health interventions, including for maternal and newborn health (MNH). This may take various forms, from participatory women's groups and community health committees to public advocacy days. While research suggests a positive influence of CE on MNH outcomes, such as mortality or care-seeking behaviour, there is a need for further evidence on the processes of CE in different settings in order to inform the future development and implementation of CE across programmes. Communication is an integral component of CE serving as a link between the programme and community. The aim of the realist review described in this protocol is to understand how, why, to what extent, and for whom CE contributes to intended and unintended outcomes in MNH programming, focusing on the communication components of CE. METHODS Realist review methodology will be used to provide a causal understanding of what communication for CE interventions in MNH programming work, for whom, to what extent, why, and how. This will be done by developing and refining programme theories on communications for CE in MNH through a systematic review of the literature and engaging key experts for input and feedback. By extrapolating context-mechanism-outcome configurations, this review seeks to understand how certain contexts trigger or inhibit specific mechanisms and what outcomes this interaction generates when communication in CE interventions is used in MNH programming. DISCUSSION A realist philosophy is well-suited to address the aims of this study because of the complex nature of CE. The review findings will be used to inform a realist evaluation case study of CE for an MNH programme in order to ascertain transferable findings that can inform and guide engagement activities in various settings. Findings will also be shared with stakeholders and experts involved in the consultative processes of the review (through workshops or policy briefs) in order to ensure the relevance of these findings to policy and practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022293564.
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Affiliation(s)
- Sara Dada
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland. .,School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Esther Namwaba Banda
- Zambia Ministry of Health, Lusaka, Zambia.,Midwives Association of Zambia, Lusaka, Zambia
| | | | | | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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11
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Hoverd EJ, Hawker-Bond G, Staniszewska S, Dale J. Factors influencing decisions about whether to participate in health research by people of diverse ethnic and cultural backgrounds: a realist review. BMJ Open 2022; 12:e058380. [PMID: 35589353 PMCID: PMC9121482 DOI: 10.1136/bmjopen-2021-058380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To develop and refine a programme theory that explains factors that influence decisions to take part in health research by people of diverse ethnic and cultural backgrounds. DESIGN Realist review following a sequence of five steps: (a) scoping search and identification of programme theory; (b) evidence searching; (c) critical appraisal and data extraction; (d) organisation of evidence and (e) refinement of programme theory. ELIGIBILITY CRITERIA Documents (including peer-reviewed articles, grey literature, websites, reports and conference papers) either full text, or a section of relevance to the overarching research question were included. DATA SOURCES EMBASE, Medline, Web of Science, Psych Info, Google and Google Scholar were searched iteratively between May and August 2020. Search strategy was refined for each database providing a broad enough review for building of programme theory. ANALYSIS Data from eligible documents was extracted to build understanding of the factors that influence decision-making. Data were mapped to create a data matrix according to context (C), mechanism (M), outcome (O), configurations (C) (CMOCs) for the process of informed consent, to aid interpretation and produce final programme theory. RESULTS 566 documents were screened and 71 included. Final programme theory was underpinned by CMOCs on processes influencing decisions to take part in research. Key findings indicate the type of infrastructure required, for example, resources, services and policies, to support inclusion in health research, with a greater need to increase the social presence of researchers within communities, improve cultural competency of individuals and organisations, reduce the complexity of participant information, and provide additional resources to support adaptive processes and shared decision making. CONCLUSION The review indicates the need for a more inclusive research infrastructure that facilitates diverse participation in health research through incorporating adaptive processes that support shared decision making within the informed consent process and in the conduct of research projects.
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Affiliation(s)
| | - George Hawker-Bond
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | | | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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Akondeng C, Njamnshi WY, Mandi HE, Agbor VN, Bain LE, Njamnshi AK. Community engagement in research in sub-Saharan Africa: approaches, barriers, facilitators, ethical considerations and the role of gender - a systematic review protocol. BMJ Open 2022; 12:e057922. [PMID: 35545398 PMCID: PMC9096545 DOI: 10.1136/bmjopen-2021-057922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Meaningful community engagement (CE) is increasingly being considered the major determinant of successful research, innovation and intervention uptake. Community leaders, policy makers and funders have expressed the need to engage communities in research. CE in research empowers the host community to participate in addressing its own health needs and health disparities while ensuring that researchers understand community priorities. Thus, appropriate CE opens a unique way to promote coproduction, coimplementation and coevaluation, which may strengthen both the sense of inclusion, ownership and the effectiveness of the research life-cycle. The aim of this review is to synthesise available evidence on how to engage communities in research in a gender-sensitive, ethical, culture-appropriate and sustainable way in sub-Saharan Africa (SSA). This protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and follows the guidance provided by the Cochrane Handbook for Systematic Reviews. METHODS AND ANALYSIS A combination of key text words and medical subject headings such as 'Community Engagement' or 'Community Involvement' will be used to search 009 databases for all literature published between 1 January 2000 and 31 July 2021. Citations retrieved from database searches will be exported into EndNote X9 to remove duplicate citations and imported into Rayyan QCRI for screening. Two independent reviewers will conduct the screening and data extraction process. Disagreements between review authors will be resolved through discussions, consensus a third reviewer serving as a tiebreaker. The risk of bias will be assessed using the 10-item Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The three-staged process described by Thomas and Harden will be used for the thematic and narrative synthesis of findings. ETHICS AND DISSEMINATION This is a systematic review which uses already collected data thus ethical approval not required. Findings will be published in an open access peer-reviewed journal and presented in relevant conferences and workshops. PROSPERO REGISTRATION NUMBER This protocol has been submitted for registration in PROSPERO and has been published under registration number CRD42021282503 .
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Affiliation(s)
- Claudine Akondeng
- Clinical Reseach Department, Brain Research Africa Initiative, Yaounde, Cameroon
- Department of programs, Cameroon National Association for Family Welfare (CAMNAFAW), Yaounde, Cameroon
| | - Wepnyu Y Njamnshi
- Clinical Reseach Department, Brain Research Africa Initiative, Yaounde, Cameroon
- Education and Training department, Education and Learning for All (ELFA), Yaounde, Cameroon
| | - Henshaw Eyambe Mandi
- Triangle Research Foundation (TRIFT), Limbe, Cameroon
- Department of Vaccine Research Developement, Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | - Valirie Ndip Agbor
- Clinical Trials and Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Luchuo Engelbert Bain
- Triangle Research Foundation (TRIFT), Limbe, Cameroon
- Lincoln International Institute for Rural Health, LIIRH, College of Social Science, Lincoln University, Lincoin, UK
| | - Alfred K Njamnshi
- Clinical Reseach Department, Brain Research Africa Initiative, Yaounde, Cameroon
- Education and Training department, Education and Learning for All (ELFA), Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaounde, Yaounde, Cameroon
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13
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Kaehler N, Adhikari B, Cheah PY, von Seidlein L, Day NPJ, Dondorp AM, Pell C. Community engagement for malaria elimination in the Greater Mekong Sub-region: a qualitative study among malaria researchers and policymakers. Malar J 2022; 21:46. [PMID: 35164770 PMCID: PMC8845385 DOI: 10.1186/s12936-022-04069-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Community engagement has increasingly received attention in malaria research and programme interventions, particularly as countries aim for malaria elimination. Although community engagement strategies and activities are constantly developing, little is known about how those who implement research or programmes view community engagement. This article explores the perspectives of researchers and policy makers in the Greater Mekong Sub-region (GMS) on community engagement for malaria control and elimination.
Methods
Semi-structured interviews were conducted among 17 policymakers and 15 senior researchers working in the field of malaria. All interviews were audio-recorded and transcribed in English. Transcribed data were analysed using deductive and inductive approaches in QSR NVivo. Themes and sub-themes were generated.
Results
Researchers and policymakers emphasized the importance of community engagement in promoting participation in malaria research and interventions. Building trust with the community was seen as crucial. Respondents emphasized involving authority/leadership structures and highlighted the need for intense and participatory engagement. Geographic remoteness, social, cultural, and linguistic diversity were identified as barriers to meaningful engagement. Local staff were described as an essential ‘connect’ between researchers or policymakers and prospective participants. Sharing information with community members, using various strategies including creative and participatory methods were highlighted.
Conclusions
Policymakers and researchers involved in malaria prevention and control in the GMS viewed community engagement as crucial for promoting participation in research or programmatic interventions. Given the difficulties of the ‘last mile’ to elimination, sustained investment in community engagement is needed in isolated areas of the GMS where malaria transmission continues. Involving community-based malaria workers is ever more critical to ensure the elimination efforts engage hard-to-reach populations in remote areas of GMS.
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Klingberg S, Adhikari B, Draper CE, Bosire EN, Tiigah P, Nyirenda D, Mukumbang FC. Engaging communities in non-communicable disease research and interventions in low- and middle-income countries: a realist review protocol. BMJ Open 2021; 11:e050632. [PMID: 34290072 PMCID: PMC8296813 DOI: 10.1136/bmjopen-2021-050632] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Engaging communities and intended beneficiaries at various stages of health research is a recommended practice. The contribution of community engagement to non-communicable disease research in low- and middle-income countries has not yet been extensively studied or synthesised. This protocol describes the steps towards generating an understanding of community engagement in the context of non-communicable disease research, prevention and health promotion using a realist review approach. A realist lens enables a rich explanatory approach to causation while capturing complexity, and an openness to multiple outcomes, including unintended consequences. The review will thus develop an understanding of community engagement without assuming that such practices result in more ethical research or effective interventions. METHODS AND ANALYSIS We propose a realist approach aiming to examine how, why, under what circumstances and for whom community engagement works or does not work. The iterative review steps include clarifying the review scope; searching for evidence; appraising studies and extracting data; synthesising evidence and drawing conclusions; and disseminating, implementing and evaluating the findings. Principles of meta-narrative review (pragmatism, pluralism, historicity, contestation, reflexivity and peer review) are employed to ensure practicable and contextualised review outputs. The proposed review will draw on theoretical and empirical literature beyond specific diseases or settings, but with a focus on informing non-communicable disease research and interventions in low- and middle-income countries. The synthesis of existing literature will be complemented by qualitative realist interviews and stakeholder consultation. Through drawing on multiple types of evidence and input from both experts and intended beneficiaries, the review will provide critical and pragmatic insights for research and community engagement in low- and middle-income countries. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of the Witwatersrand. Dissemination will include traditional academic channels, institutional communications, social media and discussions with a wide range of stakeholders.
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Affiliation(s)
- Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Edna N Bosire
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Priscilla Tiigah
- Health Equity and Strategy Unit, Public Health England, London, UK
| | - Deborah Nyirenda
- Community Engagement and Bioethics, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre, Malawi
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15
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Kakuhikire B, Satinsky EN, Baguma C, Rasmussen JD, Perkins JM, Gumisiriza P, Juliet M, Ayebare P, Mushavi RC, Burns BFO, Evans CQ, Siedner MJ, Bangsberg DR, Tsai AC. Correlates of attendance at community engagement meetings held in advance of bio-behavioral research studies: A longitudinal, sociocentric social network study in rural Uganda. PLoS Med 2021; 18:e1003705. [PMID: 34270581 PMCID: PMC8323877 DOI: 10.1371/journal.pmed.1003705] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/30/2021] [Accepted: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Community engagement is central to the conduct of health-related research studies as a way to determine priorities, inform study design and implementation, increase recruitment and retention, build relationships, and ensure that research meets the goals of the community. Community sensitization meetings, a form of community engagement, are often held prior to the initiation of research studies to provide information about upcoming study activities and resolve concerns in consultation with potential participants. This study estimated demographic, health, economic, and social network correlates of attendance at community sensitization meetings held in advance of a whole-population, combined behavioral, and biomedical research study in rural Uganda. METHODS AND FINDINGS Research assistants collected survey data from 1,630 adults participating in an ongoing sociocentric social network cohort study conducted in a rural region of southwestern Uganda. These community survey data, collected between 2016 and 2018, were linked to attendance logs from community sensitization meetings held in 2018 and 2019 before the subsequent community survey and community health fair. Of all participants, 264 (16%) attended a community sensitization meeting before the community survey, 464 (28%) attended a meeting before the community health fair, 558 (34%) attended a meeting before either study activity (survey or health fair), and 170 (10%) attended a meeting before both study activities (survey and health fair). Using multivariable Poisson regression models, we estimated correlates of attendance at community sensitization meetings. Attendance was more likely among study participants who were women (adjusted relative risk [ARR]health fair = 1.71, 95% confidence interval [CI], 1.32 to 2.21, p < 0.001), older age (ARRsurvey = 1.02 per year, 95% CI, 1.01 to 1.02, p < 0.001; ARRhealth fair = 1.02 per year, 95% CI, 1.01 to 1.02, p < 0.001), married (ARRsurvey = 1.74, 95% CI, 1.29 to 2.35, p < 0.001; ARRhealth fair = 1.41, 95% CI, 1.13 to 1.76, p = 0.002), and members of more community groups (ARRsurvey = 1.26 per group, 95% CI, 1.10 to 1.44, p = 0.001; ARRhealth fair = 1.26 per group, 95% CI, 1.12 to 1.43, p < 0.001). Attendance was less likely among study participants who lived farther from meeting locations (ARRsurvey = 0.54 per kilometer, 95% CI, 0.30 to 0.97, p = 0.041; ARRhealth fair = 0.57 per kilometer, 95% CI, 0.38 to 0.86, p = 0.007). Leveraging the cohort's sociocentric design, social network analyses suggested that information conveyed during community sensitization meetings could reach a broader group of potential study participants through attendees' social network and household connections. Study limitations include lack of detailed data on reasons for attendance/nonattendance at community sensitization meetings; achieving a representative sample of community members was not an explicit aim of the study; and generalizability may not extend beyond this study setting. CONCLUSIONS In this longitudinal, sociocentric social network study conducted in rural Uganda, we observed that older age, female sex, being married, membership in more community groups, and geographical proximity to meeting locations were correlated with attendance at community sensitization meetings held in advance of bio-behavioral research activities. Information conveyed during meetings could have reached a broader portion of the population through attendees' social network and household connections. To ensure broader input and potentially increase participation in health-related research studies, the dissemination of research-related information through community sensitization meetings may need to target members of underrepresented groups.
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Affiliation(s)
| | - Emily N. Satinsky
- Department of Psychology, University of Southern California, Los Angeles, California, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Justin D. Rasmussen
- Department of Psychology, Duke University, Durham, North Carolina, United States of America
| | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | | | - Mercy Juliet
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rumbidzai C. Mushavi
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bridget F. O. Burns
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Boston, Massachusetts, United States of America
| | - Claire Q. Evans
- Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Mark J. Siedner
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health and Science University - Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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16
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Laura T, Deborah C, Rona C. Community mobilisation approaches to preventing and reducing adolescent multiple risk behaviour: a realist review protocol. Syst Rev 2021; 10:147. [PMID: 33980307 PMCID: PMC8117311 DOI: 10.1186/s13643-021-01696-4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/30/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Adolescent multiple risk behaviour (MRB) continues to be a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, rather than targeting the wider environmental or structural context. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. Despite this, there are gaps in the current literature, theory and implementation that would benefit from a realist approach due to the suitability of this methodology to analysing complex interventions. The objective of this study is to understand 'how, why, for whom and in what circumstances and time periods' do community mobilisation interventions work to prevent and/or reduce adolescent multiple risk behaviour. METHODS This is a protocol for a realist review. The review will use a six-stage iterative process, guided by the RAMESES framework. We will systematically search PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological Abstracts, from their inception to 2021. Studies will be screened for relevance to the programme theory and included based on a priori eligibility criteria including (1) reporting a community mobilisation intervention (2) targeting two health risk behaviors (3) for adolescent populations. Two independent reviewers will select, screen and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome configurations that contribute to our programme theory. The findings will be synthesised to produce a refined programme theory model. DISCUSSION The goal of this realist review is to identify and refine a programme theory for community mobilisation approaches to the prevention and/or reduction of adolescent multiple risk behaviour. Our aim is that the findings surrounding the programme theory refinement can be used to develop and implement adolescent multiple risk behaviour interventions and maintain collaboration between local policy makers, researchers and community members. SYSTEMATIC REVIEW REGISTRATION This realist review is registered on the PROSPERO database (registration number: CRD42020205342).
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Affiliation(s)
- Tinner Laura
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL UK
| | - Caldwell Deborah
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL UK
| | - Campbell Rona
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL UK
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Ahmed SAKS, Ajisola M, Azeem K, Bakibinga P, Chen YF, Choudhury NN, Fayehun O, Griffiths F, Harris B, Kibe P, Lilford RJ, Omigbodun A, Rizvi N, Sartori J, Smith S, Watson SI, Wilson R, Yeboah G, Aujla N, Azam SI, Diggle PJ, Gill P, Iqbal R, Kabaria C, Kisia L, Kyobutungi C, Madan JJ, Mberu B, Mohamed SF, Nazish A, Odubanjo O, Osuh ME, Owoaje E, Oyebode O, Porto de Albuquerque J, Rahman O, Tabani K, Taiwo OJ, Tregonning G, Uthman OA, Yusuf R. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements. BMJ Glob Health 2020; 5:e003042. [PMID: 32819917 PMCID: PMC7443197 DOI: 10.1136/bmjgh-2020-003042] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. METHODS In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns. RESULTS Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. CONCLUSION Slum residents' ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.
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Affiliation(s)
- Syed A K Shifat Ahmed
- Centre for Health, Population and Development, Independent University Bangladesh, Dhaka, Bangladesh
| | - Motunrayo Ajisola
- National Institute for Health Research Project, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Kehkashan Azeem
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | | | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Olufunke Fayehun
- Department of Sociology, Faculty of Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Bronwyn Harris
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Kibe
- African Population and Health Research Center, Nairobi, Kenya
| | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Narjis Rizvi
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | - Jo Sartori
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Simon Smith
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Samuel I Watson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ria Wilson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Godwin Yeboah
- Institute for Global Sustainable Development, University of Warwick, Coventry, UK
| | - Navneet Aujla
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Syed Iqbal Azam
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | - Peter J Diggle
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Romaina Iqbal
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | | | - Lyagamula Kisia
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Jason J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Shukri F Mohamed
- African Population and Health Research Center, Nairobi, Kenya
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ahsana Nazish
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | | | - Mary E Osuh
- Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Eme Owoaje
- Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Oyinlola Oyebode
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Omar Rahman
- University of Liberal Arts Bangladesh, Dhaka, Bangladesh
| | - Komal Tabani
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | - Olalekan John Taiwo
- Department of Geography, Faculty of Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Grant Tregonning
- Institute for Global Sustainable Development, University of Warwick, Coventry, UK
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rita Yusuf
- Centre for Health, Population and Development, Independent University Bangladesh, Dhaka, Bangladesh
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18
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Lek D, Callery JJ, Nguon C, Debackere M, Sovannaroth S, Tripura R, Wojnarski M, Piola P, Khean ST, Manion K, Nguon S, Kunkel A, Vernaeve L, Peto TJ, Dantzer E, Davoeung C, Etienne W, Dondorp AM, Tuseo L, von Seidlein L, Guintran JO. Tools to accelerate falciparum malaria elimination in Cambodia: a meeting report. Malar J 2020; 19:151. [PMID: 32293452 PMCID: PMC7161105 DOI: 10.1186/s12936-020-03197-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/20/2020] [Indexed: 02/06/2023] Open
Abstract
Cambodia targets malaria elimination by 2025. Rapid elimination will depend on successfully identifying and clearing malaria foci linked to forests. Expanding and maintaining universal access to early diagnosis and effective treatment remains the key to malaria control and ultimately malaria elimination in the Greater Mekong Subregion (GMS) in the foreseeable future. Mass Drug Administration (MDA) holds some promise in the rapid reduction of Plasmodium falciparum infections, but requires considerable investment of resources and time to mobilize the target communities. Furthermore, the most practical drug regimen for MDA in the GMS—three rounds of DHA/piperaquine—has lost some of its efficacy. Mass screening and treatment benefits asymptomatic P. falciparum carriers by clearing chronic infections, but in its current form holds little promise for malaria elimination. Hopes that “highly sensitive” diagnostic tests would provide substantial advances in screen and treat programmes have been shown to be misplaced. To reduce the burden on P. falciparum and Plasmodium vivax infections in people working in forested areas novel approaches to the use of malaria prophylaxis in forest workers should be explored. During an October 2019 workshop in Phnom Penh researchers and policymakers reviewed evidence of acceptability, feasibility and effectiveness of interventions to target malaria foci and interrupt P. falciparum transmission and discussed operational requirements and conditions for programmatic implementation.
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Affiliation(s)
- Dysoley Lek
- Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - James J Callery
- Mahidol-Oxford University Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Chea Nguon
- Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Siv Sovannaroth
- Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Rupam Tripura
- Mahidol-Oxford University Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Marius Wojnarski
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Soy Ty Khean
- University Research Company Ltd., Phnom Penh, Cambodia.,London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sokomar Nguon
- University Research Company Ltd., Phnom Penh, Cambodia
| | - Amber Kunkel
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
| | | | - Thomas J Peto
- Mahidol-Oxford University Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Emily Dantzer
- University of California at San Francisco, San Francisco, USA
| | | | | | - Arjen M Dondorp
- Mahidol-Oxford University Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Lorenz von Seidlein
- Mahidol-Oxford University Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | - Jean-Olivier Guintran
- Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia. .,Mahidol-Oxford University Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
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19
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Adhikari B, Pell C, Cheah PY. Community engagement and ethical global health research. Glob Bioeth 2019; 31:1-12. [PMID: 32002019 PMCID: PMC6968663 DOI: 10.1080/11287462.2019.1703504] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 12/06/2019] [Indexed: 11/27/2022] Open
Abstract
Community engagement is increasingly recognized as a critical element of medical research, recommended by ethicists, required by research funders and advocated in ethics guidelines. The benefits of community engagement are often stressed in instrumental terms, particularly with regard to promoting recruitment and retention in studies. Less emphasis has been placed on the value of community engagement with regard to ethical good practice, with goals often implied rather than clearly articulated. This article outlines explicitly how community engagement can contribute to ethical global health research by complementing existing established requirements such as informed consent and independent ethics review. The overarching and interlinked areas are (1) respecting individuals, communities and stakeholders; (2) building trust and social relationships; (3) determining appropriate benefits; minimizing risks, burdens and exploitation; (4) supporting the consent process; (5) understanding vulnerabilities and researcher obligations; (6) gaining permissions, approvals and building legitimacy and (7) achieving recruitment and retention targets.
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Affiliation(s)
- Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK.,Kellogg College, University of Oxford, Oxford, UK
| | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK.,The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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