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Admassu M, Benova L, Nöstlinger C, Semaan A, Christou A, Nieto-Sanchez C, Laga M, Endriyas M, Delvaux T. Uncovering community needs regarding violence against women and girls in southern Ethiopia: An explorative study. PLoS One 2024; 19:e0304459. [PMID: 38861511 PMCID: PMC11166345 DOI: 10.1371/journal.pone.0304459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Violence against women and girls (VAWG) is a significant global public health problem and a violation of human rights experienced by one in three women worldwide. This study explores community perceptions of and responses to VAWG and challenges in accessing support services among female violence survivors in Arbaminch City. METHODS We adopted a phenomenological explorative qualitative study design. A total of 62 participants including female violence survivors, religious leaders, service providers, police, women, and men in participated in interviews, focus group discussions, and observations in August 2022. Participants were selected purposively, and the findings were analyzed thematically. We applied data source and respondent triangulation to increase the findings' trustworthiness. RESULTS Community perceptions of VAWG, specifically of intimate partner violence (IPV) and non-partner sexual violence (NPSV), varied depending on gender, age, and social position. IPV and NPSV were normalized through tolerance and denial by young and married men, while resistance to all forms of violence was common among women. Survivors of violence responded to the act of violence by leaving their homes, separating from their husbands, or taking harsh actions against their husbands, such as murder. Support for VAWG survivors was available through health care, free legal services, and a temporary shelter. Yet factors ranging from individual to societal levels, such as fear, lack of knowledge, lack of family and community support, and social and legal injustice, were barriers to accessing existing services. Nonetheless, violence survivors desired to speak about their experiences and seek psychosocial support. CONCLUSIONS Our qualitative evidence gathered here can inform tailored VAWG prevention and response services such as interventions to shift social norms and the perception towards VAWG among different population group through raising awareness in schools, health care settings, faith-based venues, and using social media.
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Affiliation(s)
- Metasebia Admassu
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | | | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Aliki Christou
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | | | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Misganu Endriyas
- Southern Nations Nationality People’s Region, Regional Health Bureau, Hawassa, Ethiopia
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
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Raj A, Dey A, Rao N, Yore J, McDougal L, Bhan N, Silverman JG, Hay K, Thomas EE, Fotso JC, Lundgren R. The EMERGE framework to measure empowerment for health and development. Soc Sci Med 2024; 351 Suppl 1:116879. [PMID: 38825382 DOI: 10.1016/j.socscimed.2024.116879] [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: 04/14/2023] [Revised: 01/24/2024] [Accepted: 04/09/2024] [Indexed: 06/04/2024]
Abstract
RATIONALE Women's empowerment is a UN Sustainable Development Goal and a focus of global health and development but survey measures and data on gender empowerment remain weak. Existing indicators are often disconnected from theory; stronger operationalization is needed. OBJECTIVE We present the EMERGE Framework to Measure Empowerment, a framework to strengthen empowerment measures for global health and development. METHOD We initiated development of this framework in 2016 as part of EMERGE - an initiative designed to build the science of survey research and availability of high-quality survey measures and data on gender empowerment. The framework is guided by existing theories of empowerment, evidence, and expert input. We apply this framework to understand women's empowerment in family planning (FP) via review of state of the field measures. RESULTS Our framework offers concrete measurable constructs to assess critical consciousness and choice, agency and backlash, and goal achievement as the empowerment process, recognizing its operation at multiple levels-from the individual to the collective. Internal attributes, social norms, and external contexts and resources create facilitators or barriers to the empowerment process. Review of best evidence FP measures assessing empowerment constructs, social norms, and key influencers (e.g., partners and providers) show a strong landscape of measures, including those with women, partners, and providers, but they are limited in assessing translation of choice to agency to achievement of women's self-determined fertility or contraceptive goals, instead relying on assumption of contraceptive use as the goal. We see no measures on collective empowerment toward women's reproductive choice and rights. CONCLUSION The EMERGE Framework can guide development and analysis of survey measures on empowerment and is needed as the current state of the field shows limited coverage of empowerment constructs even in areas which have received more study, such as family planning.
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Affiliation(s)
- Anita Raj
- Newcomb Institute, Tulane University, 43 Newcomb Place, Suite 301, New Orleans, LA, 70118, USA; Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2460 #8329, New Orleans, LA, 70112, USA; Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA.
| | - Arnab Dey
- Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA
| | - Namratha Rao
- Newcomb Institute, Tulane University, 43 Newcomb Place, Suite 301, New Orleans, LA, 70118, USA
| | - Jennifer Yore
- Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA
| | - Lotus McDougal
- Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA
| | - Nandita Bhan
- O.P. Jindal Global University, Sonipat Narela Road, Near Jagdishpur Village, Sonipat, Haryana, 131001, India
| | - Jay G Silverman
- Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2460 #8329, New Orleans, LA, 70112, USA
| | - Katherine Hay
- Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA
| | - Edwin E Thomas
- Newcomb Institute, Tulane University, 43 Newcomb Place, Suite 301, New Orleans, LA, 70118, USA
| | | | - Rebecka Lundgren
- Center on Gender Equity and Health, University of California, San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093, USA
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Xie YJ, Liao X, Lin M, Yang L, Cheung K, Zhang Q, Li Y, Hao C, Wang HH, Gao Y, Zhang D, Molassiotis A, Siu GKH, Leung AYM. Community Engagement in Vaccination Promotion: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e49695. [PMID: 38478914 PMCID: PMC11127135 DOI: 10.2196/49695] [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: 06/06/2023] [Revised: 09/27/2023] [Accepted: 02/27/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Community engagement plays a vital role in global immunization strategies, offering the potential to overcome vaccination hesitancy and enhance vaccination confidence. Although there is significant backing for community engagement in health promotion, the evidence supporting its effectiveness in vaccination promotion is fragmented and of uncertain quality. OBJECTIVE This review aims to systematically examine the effectiveness of different contents and extent of community engagement for promoting vaccination rates. METHODS This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive and exhaustive literature search was performed in 4 English databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 Chinese databases (CNKI and Wan Fang) to identify all possible articles. Original research articles applying an experimental study design that investigated the effectiveness of community engagement in vaccination promotion were eligible for inclusion. Two reviewers independently performed the literature search, study selection, quality assessment, and data extraction. Discrepancies were resolved through discussion, with the arbitration of a third reviewer where necessary. RESULTS A total of 20 articles out of 11,404 records from 2006 to 2021 were retrieved. The studies used various designs: 12 applied single-group pre-post study designs, 5 were cluster randomized controlled trials (RCTs), and 3 were non-RCTs. These studies targeted multiple vaccines, with 8 focusing on children's immunization, 8 on human papillomavirus vaccine, 3 on hepatitis B virus vaccine, and 1 on COVID-19 vaccine. The meta-analysis revealed significant increases in vaccination rates both in pre-post comparison (rate difference [RD] 0.34, 95% CI 0.21-0.47, I2=99.9%, P<.001) and between-group comparison (RD 0.18, 95% CI 0.07-0.29, I2=98.4%, P<.001). The meta-analysis revealed that participant recruitment had the largest effect size (RD 0.51, 95% CI 0.36-0.67, I2=99.9%, P<.001), followed by intervention development (RD 0.36, 95% CI 0.23-0.50, I2=100.0%, P<.001), intervention implementation (RD 0.35, 95% CI 0.22-0.47, I2=99.8%, P<.001), and data collection (RD 0.34, 95% CI 0.19-0.50, I2=99.8%, P<.001). The meta-analysis indicated that high community engagement extent yielded the largest effect size (RD 0.49, 95% CI 0.17-0.82, I2=100.0%, P<.001), followed by moderate community engagement extent (RD 0.45, 95% CI 0.33-0.58, I2=99.6%, P<.001) and low community engagement extent (RD 0.15, 95% CI 0.05-0.25, I2=99.2%, P<.001). The meta-analysis revealed that "health service support" demonstrated the largest effect sizes (RD 0.45, 95% CI 0.25-0.65, I2=99.9%, P<.001), followed by "health education and discussion" (RD 0.39, 95% CI 0.20-0.58, I2=99.7%, P<.001), "follow-up and reminder" (RD 0.33, 95% CI 0.23-0.42, I2=99.3%, P<.001), and "social marketing campaigns and community mobilization" (RD 0.24, 95% CI 0.06-0.41, I2=99.9%, P<.001). CONCLUSIONS The results of this meta-analysis supported the effectiveness of community engagement in vaccination promotion with variations in terms of engagement contents and extent. Community engagement required a "fit-for-purpose" approach rather than a "one-size-fits-all" approach to maximize the effectiveness of vaccine promotion. TRIAL REGISTRATION PROSPERO CRD42022339081; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339081.
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Affiliation(s)
- Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Xiaoli Liao
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Meijuan Lin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Lin Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Harry Hx Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Usher Institute, Deanery of Molecular, Genetic & Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Dexing Zhang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Alex Molassiotis
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Gilman Kit Hang Siu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Angela Yee Man Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
- Research Institute on Smart Aging (RISA), The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
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Stover J, Avadhanula L, Sood S. A review of strategies and levels of community engagement in strengths-based and needs-based health communication interventions. Front Public Health 2024; 12:1231827. [PMID: 38655513 PMCID: PMC11035763 DOI: 10.3389/fpubh.2024.1231827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/14/2024] [Indexed: 04/26/2024] Open
Abstract
Background Community engagement is key in health communication interventions that seek to incorporate community voices in their planning and implementation. Understanding what approaches and strategies are currently being used can help tailor programs in different social and cultural contexts. This review explores needs-based and strengths-based approaches and consensus and conflict strategies in community-based global health communications programs. Our objective is to examine the current state of the field, outline lessons learned, and identify gaps in existing programming to help guide future interventions. Methods PubMed and Web of Science were searched for articles published between 2010 and 2023. Studies were included if they described a community-based health communication intervention and an ongoing or completed implementation. Interventions were coded then categorized according to their level of community engagement and as single, hybrid, or complex, depending upon the number of approaches and strategies used. Results The search yielded 678 results and 42 were included in the final review and analysis. A vast majority 34 (81.0%) interventions utilized a needs-based approach and 24 (57.1%) utilized a strengths-based approach. Consensus as a strategy was utilized in 38 (90.5%) of the manuscripts and 9 (21.4%) implemented a conflict strategy. Interventions that combined approaches and strategies were more likely to leverage a higher level of community engagement. Conclusion These results showcase the complicated nature of global health communication program planning and implementation. There is a lack of interventions that use conflict as a strategy to empower communities to act on their own behalf, even when at odds with existing power structures. Complex interventions that include all approaches and strategies demonstrate the potential for global health communication interventions to be at the cutting edge of public health practice.
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Affiliation(s)
- Jesse Stover
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Laxmisupriya Avadhanula
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Suruchi Sood
- Johns Hopkins Center for Communication Programs, Department of Health Behavior and Society, Bloomberg School of Public Health, Baltimore, MD, United States
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Kjellström S, Sarre S, Masterson D. The complexity of leadership in coproduction practices: a guiding framework based on a systematic literature review. BMC Health Serv Res 2024; 24:219. [PMID: 38368329 PMCID: PMC10873973 DOI: 10.1186/s12913-024-10549-4] [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: 04/11/2023] [Accepted: 01/03/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND As coproduction in public services increases, understanding the role of leadership in this context is essential to the tasks of establishing relational partnerships and addressing power differentials among groups. The aims of this review are to explore models of coproduction leadership and the processes involved in leading coproduction as well as, based on that exploration, to develop a guiding framework for coproduction practices. METHODS A systematic review that synthesizes the evidence reported by 73 papers related to coproduction of health and welfare. RESULTS Despite the fact that models of coleadership and collective leadership exhibit a better fit with the relational character of coproduction, the majority of the articles included in this review employed a leader-centric underlying theory. The practice of coproduction leadership is a complex activity pertaining to interactions among people, encompassing nine essential practices: initiating, power-sharing, training, supporting, establishing trust, communicating, networking, orchestration, and implementation. CONCLUSIONS This paper proposes a novel framework for coproduction leadership practices based on a systematic review of the literature and a set of reflective questions. This framework aims to help coproduction leaders and participants understand the complexity, diversity, and flexibility of coproduction leadership and to challenge and enhance their capacity to collaborate effectively.
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Affiliation(s)
- Sofia Kjellström
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, Jönköping, Sweden.
| | - Sophie Sarre
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Daniel Masterson
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, Jönköping, Sweden
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Gadeka DD, Akweongo P, Whyle E, Aryeetey GC, Aheto JM, Gilson L. Role of actor networks in primary health care implementation in low- and middle-income countries: a scoping review. Glob Health Action 2023; 16:2206684. [PMID: 37133244 PMCID: PMC10158548 DOI: 10.1080/16549716.2023.2206684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Primary health care (PHC) improvement is often undermined by implementation gaps in low- and middle-income countries (LMICs). The influence that actor networks might have on the implementation has received little attention up to this point. OBJECTIVE This study sought to offer insights about actor networks and how they support PHC implementation in LMICs. METHODS We reviewed primary studies that utilised social network analysis (SNA) to determine actor networks and their influence on aspects of PHC in LMICs following the five-stage scoping review methodological framework by Arksey and O'Malley. Narrative synthesis was applied to describe the included studies and the results. RESULTS Thirteen primary studies were found eligible for this review. Ten network types were identified from the included papers across different contexts and actors: professional advice networks, peer networks, support/supervisory networks, friendship networks, referral networks, community health committee (CHC) networks, inter-sectoral collaboration networks, partnership networks, communications networks, and inter-organisational network. The networks were found to support PHC implementation at patient/household or community-level, health facility-level and multi-partner networks that work across levels. The study demonstrates that: (1) patient/household or community-level networks promote early health-seeking, continuity of care and inclusiveness by enabling network members (actors) the support that ensures access to PHC services, (2) health facility-level networks enable collaboration among PHC staff and also ensure the building of social capital that enhances accountability and access to community health services, and (3) multi-partner networks that work across levels promote implementation by facilitating information and resource sharing, high professional trust and effective communication among actors. CONCLUSION This body of literature reviewed suggests that, actor networks exist across different levels and that they make a difference in PHC implementation. Social Network Analysis may be a useful approach to health policy analysis (HPA) on implementation.
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Affiliation(s)
- Dominic Dormenyo Gadeka
- Department of Health Policy, Planning and Management, University of Ghana School of Public Health, Legon-Accra, Ghana
| | - Patricia Akweongo
- Department of Health Policy, Planning and Management, University of Ghana School of Public Health, Legon-Accra, Ghana
| | - Eleanor Whyle
- Division of Health Policy and Systems, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Genevieve Cecilia Aryeetey
- Department of Health Policy, Planning and Management, University of Ghana School of Public Health, Legon-Accra, Ghana
| | - Justice Moses Aheto
- Department of Biostatistics, University of Ghana School of Public Health, Legon-Accra, Ghana
| | - Lucy Gilson
- Division of Health Policy and Systems, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Iuliano A, Shittu F, Colbourn T, Salako J, Bakare D, Bakare AAA, King C, Graham H, McCollum ED, Falade AG, Uchendu O, Haruna I, Valentine P, Burgess R. Community perceptions matter: a mixed-methods study using local knowledge to define features of success for a community intervention to improve quality of care for children under-5 in Jigawa, Nigeria. BMJ Open 2023; 13:e069213. [PMID: 37973546 PMCID: PMC10660644 DOI: 10.1136/bmjopen-2022-069213] [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: 10/19/2022] [Accepted: 09/22/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES In this study, we used the information generated by community members during an intervention design process to understand the features needed for a successful community participatory intervention to improve child health. DESIGN We conducted a concurrent mixed-methods study (November 2019-March 2020) to inform the design and evaluation of a community-facility linkage participatory intervention. SETTING Kiyawa Local Government Area (Jigawa State, Nigeria)-population of 230 000 (n=425 villages). PARTICIPANTS Qualitative data included 12 community conversations with caregivers of children under-5 (men, older and younger women; n=9 per group), 3 focus group discussions (n=10) with ward development committee members and interviews with facility heads (n=3). Quantitative data comprised household surveys (n=3464) with compound heads (n=1803) and women (n=1661). RESULTS We analysed qualitative data with thematic network analysis and the surveys with linear regression-results were triangulated in the interpretation phase. Participants identified the following areas of focus: community health education; facility infrastructure, equipment and staff improvements; raising funds to make these changes. Community involvement, cooperation and empowerment were recognised as a strategy to improve child health, and the presence of intermediate bodies (development committees) was deemed important to improve communication and solve problems between community and facility members. The survey showed functional community relations' dynamics, with high levels of internal cohesion (78%), efficacy in solving problems together (79%) and fairness of the local leaders (82%). CONCLUSIONS Combining the results from this study and critical theories on successful participation identified community-informed features for a contextually tailored community-facility link intervention. The need to promote a more inclusive approach to future child health interventions was highlighted. In addition to health education campaigns, the relationship between community and healthcare providers needs strengthening, and development committees were identified as an essential feature for successfully linking communities and facilities for child health. TRIAL REGISTRATION NUMBER ISRCTN39213655.
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Affiliation(s)
- Agnese Iuliano
- UCL Institute for Global Health, University College London, London, UK
| | - Funmilayo Shittu
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Timothy Colbourn
- UCL Institute for Global Health, University College London, London, UK
| | - Julius Salako
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Damola Bakare
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Ayobami Adebayo A Bakare
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
| | - Carina King
- UCL Institute for Global Health, University College London, London, UK
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Hamish Graham
- Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adegoke G Falade
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
- Department of Paediatrics, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
| | - Obioma Uchendu
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - Rochelle Burgess
- UCL Institute for Global Health, University College London, London, UK
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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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Mbuo M, Okello I, Penn-Kekana L, Willcox M, Portela A, Palestra F, Mathai M. Community engagement in maternal and perinatal death surveillance and response (MPDSR): Realist review protocol. Wellcome Open Res 2023; 8:117. [PMID: 37654740 PMCID: PMC10465996 DOI: 10.12688/wellcomeopenres.18844.1] [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] [Accepted: 09/29/2023] [Indexed: 09/02/2023] Open
Abstract
Background: While there has been a decline in maternal and perinatal mortality, deaths remain high in sub-Saharan Africa and Asia. With the sustainable development goals (SDGs) targets to reduce maternal and perinatal mortality, more needs to be done to accelerate progress and improve survival. Maternal and perinatal death surveillance and response (MPDSR) is a strategy to identify the clinical and social circumstances that contribute to maternal and perinatal deaths. Through MPDSR, an active surveillance and response cycle is established by bringing together different stakeholders to review and address these social and clinical factors. Community engagement in MPDSR provides a strong basis for collective action to address social factors and quality of care issues that contribute to maternal and perinatal deaths. Studies have shown that community members can support identification and reporting of maternal and/or perinatal deaths. Skilled care at birth has been increasing globally, but there are still gaps in quality of care. Through MPDSR, community members can collaborate with health workers to improve quality of care. But we do not know how community engagement in MPDSR works in practice; for whom it works and what aspects work (or do not work) and why. This realist review answers the question: which strategies of community engagement in MPDSR produce which outcomes in which contexts? Methods : For this realist review, we will identify published and grey literature by searching relevant databases for articles. We will include papers published from 2004 in all languages and from all countries. We have set up an advisory group drawn from academia, international organizations, and practitioners of both MPDSR and community engagement to guide the process. Conclusion: This protocol and the subsequent realist review will use theoretical approaches from the community engagement literature to generate theory on community engagement in MPDSR. Prospero registration number: CRD42022345216.
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Affiliation(s)
- Mary Mbuo
- Public health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Immaculate Okello
- Primary Care Research Centre , Aldermoor Health Centre, University of Southampton, Southhampton, UK
| | - Loveday Penn-Kekana
- Public health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Merlin Willcox
- Primary Care Research Centre , Aldermoor Health Centre, University of Southampton, Southhampton, UK
| | - Anayda Portela
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Francesca Palestra
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Matthews Mathai
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Dhillon P, Unisa S, Gupta A, Saraswat A, Km S, Pedgaonkar S. Utilisation of ANC services before and after the COVID-19 pandemic in selected resource-poor blocks of India: role of community health workers in Swabhimaan programme area. BMC Health Serv Res 2023; 23:864. [PMID: 37580689 PMCID: PMC10426095 DOI: 10.1186/s12913-023-09781-1] [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: 11/25/2022] [Accepted: 07/03/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION COVID-19 has disrupted maternal and child health services. Community Health Workers (CHWs) supported the women by visiting pregnant women's homes and providing the MCH services as required. This study attempts to understand the role of CHW and its impact on the Ante-Natal Care (ANC) services pre-pandemic and post-Pandemic in the poor resource setting. METHODS The Swabhimaan programme interventions were carried out in the selected blocks in the Indian States of Bihar, Odisha and Chhattisgarh with the objective to improve the nutritional status of mothers, pregnant women and adolescents living in resource-poor blocks of three selected states during 2016-2022. Cross-sectional surveys, namely pre-pandemic (2018-19) and post-pandemic (2021-22) of pregnant and mothers of under two children, utilised to fulfil the objectives of this study. These surveys are part of Swabhimaan evaluation, a community-based non-randomised controlled study. RESULTS The ANC services received by women have increased over time from 2015 to 2022. Our findings confirm that the ground-level community and health systems were active during the pandemic, and the results show significant improvement. Additionally, the women supported by the CHW have substantially improved pregnancy registration, first ANC, Tetanus injection, consumption of Iron Folic Acid, Calcium and deworming tablets than those who did not. Propesnsity Score Matching analysis shows that the average treatment effect on the various ANC services of having the support of CHW is significant. CONCLUSION This study shows the vital role of CHWs in utilising various Maternal and Child Health services. Better linkage and networking of the CHWs with the community will ensure health service delivery regularly and in an emergency like a pandemic and develop resilience.
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Affiliation(s)
- Preeti Dhillon
- Department of Survey Research & Data Analystics, International Institute for Population Sciences, Mumbai, India
| | - Sayeed Unisa
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences, Mumbai, India.
| | - Ajay Gupta
- Swabhimaan Project, International Institute for Population Sciences, Mumbai, India
| | - Abhishek Saraswat
- Swabhimaan Project, International Institute for Population Sciences, Mumbai, India
| | - Sulaiman Km
- Swabhimaan Project, International Institute for Population Sciences, Mumbai, India
| | - Sarang Pedgaonkar
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
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11
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Smythe T, Reichenberger V, Pinzón EM, Hurtado IC, Rubiano L, Kuper H. The feasibility of establishing parent support groups for children with congenital Zika syndrome and their families: a mixed-methods study. Wellcome Open Res 2023; 6:158. [PMID: 37346815 PMCID: PMC10280024 DOI: 10.12688/wellcomeopenres.16839.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 11/07/2023] Open
Abstract
Background: The 2015 - 2016 Zika epidemic highlighted gaps in health and social care services for parents of children with developmental disabilities. In response, we developed the 'Juntos' intervention, a 10 week community-based early intervention support group for parents of children with congenital Zika syndrome (CZS). The intervention's components include participatory learning sessions, practical skill acquisition, peer support, and psychological support, aiming to improve caregiver's knowledge and confidence in caring for their children. This study aimed to evaluate the feasibility of implementing 'Juntos' in Colombia. Methods: Two facilitators delivered 'Juntos' to four groups of 8-10 caregivers between 2017 and 2018. One researcher observed each group. Data were collected from: observation notes from 40 sessions, focus group discussions held after each session, pre- post intervention questionnaires with 34 caregivers, and semi-structured interviews conducted with four facilitators, 12 caregivers and three stakeholders. We used the Bowen framework in data analysis. Results: The feasibility evaluation revealed that 'Juntos' was highly acceptable and in demand among the target population. The intervention was predominantly delivered with fidelity. Practicality was facilitated by providing transport costs and selecting convenient locations. Additional organisational and social media support was required for successful implementation. Community health worker training may support integration and the established groups could facilitate programme expansion. However, participants perceived lack of prioritisation as a limitation within existing health systems. Participants' knowledge and confidence to care for their child improved after programme enrolment. Conclusion: The 'Juntos' intervention demonstrated high acceptability, demand, and practicality in supporting parents of children with CZS in Colombia. However, its implementation faces challenges due to existing gaps in health system support for children with CZS.
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Affiliation(s)
- Tracey Smythe
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, London, UK
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12
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Smythe T, Reichenberger V, Pinzón EM, Hurtado IC, Rubiano L, Kuper H. The feasibility of establishing parent support groups for children with congenital Zika syndrome and their families: a mixed-methods study. Wellcome Open Res 2023; 6:158. [PMID: 37346815 PMCID: PMC10280024 DOI: 10.12688/wellcomeopenres.16839.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Abstract
Background: The 2015 - 2016 Zika epidemic highlighted gaps in health and social care services for parents of children with developmental disabilities. In response, we developed the 'Juntos' intervention, a 10 week community-based early intervention support group for parents of children with congenital Zika syndrome (CZS). The intervention's components include participatory learning sessions, practical skill acquisition, peer support, and psychological support, aiming to improve caregiver's knowledge and confidence in caring for their children. This study aimed to evaluate the feasibility of implementing 'Juntos' in Colombia. Methods: Two facilitators delivered 'Juntos' to four groups of 8-10 caregivers between 2017 and 2018. One researcher observed each group. Data were collected from: observation notes from 40 sessions, focus group discussions held after each session, pre- post intervention questionnaires with 34 caregivers, and semi-structured interviews conducted with four facilitators, 12 caregivers and three stakeholders. We used the Bowen framework in data analysis. Results: The feasibility evaluation revealed that 'Juntos' was highly acceptable and in demand among the target population. The intervention was predominantly delivered with fidelity. Practicality was facilitated by providing transport costs and selecting convenient locations. Additional organisational and social media support was required for successful implementation. Community health worker training may support integration and the established groups could facilitate programme expansion. However, participants perceived lack of prioritisation as a limitation within existing health systems. Participants' knowledge and confidence to care for their child improved after programme enrolment. Conclusion: The 'Juntos' intervention demonstrated high acceptability, demand, and practicality in supporting parents of children with CZS in Colombia. However, its implementation faces challenges due to existing gaps in health system support for children with CZS.
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Affiliation(s)
- Tracey Smythe
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, London, UK
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13
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Medina-Perucha L, López-Jiménez T, Jacques-Aviñó C, Holst AS, Valls-Llobet C, Munrós-Feliu J, Martínez-Bueno C, Pinzón-Sanabria D, Vicente-Hernández MM, Berenguera A. Menstruation and social inequities in Spain: a cross-sectional online survey-based study. Int J Equity Health 2023; 22:92. [PMID: 37198680 DOI: 10.1186/s12939-023-01904-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/30/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Available research suggests that menstrual inequity has an impact on (menstrual) health outcomes and emotional wellbeing. It is also a significant barrier to achieve social and gender equity and compromises human rights and social justice. The aim of this study was to describe menstrual inequities and their associations with sociodemographic factors, among women and people who menstruate (PWM) aged 18-55 in Spain. METHODS A cross-sectional survey-based study was conducted in Spain between March and July 2021. Descriptive statistical analyses and multivariate logistic regression models were performed. RESULTS A total of 22,823 women and PWM were included in the analyses (Mean age = 33.2, SD = 8.7). Over half of the participants had accessed healthcare services for menstruation (61.9%). The odds for accessing menstrual-related services were significantly higher among participants with university education (aOR: 1.48, 95% CI, 1.13-1.95). Also, 57.8% reported having had partial or no menstrual education pre-menarche, with odds being higher among participants born in non-European or Latin American countries (aOR: 0.58, 95% CI, 0.36-0.93). Lifetime self-reported menstrual poverty was between 22.2-39.9%. Main risk factors for menstrual poverty were identifying as non-binary (aOR: 1.67, 95% CI, 1.32-2.11), being born in non-European or Latin American countries (aOR: 2.74, 95% CI, 1.77-4.24), and not having a permit to reside in Spain (aOR: 4.27, 95% CI, 1.94-9.38). Completed university education (aOR: 0.61, 95% CI, 0.44-0.84) and no financial hardship < 12 months (aOR: 0.06, 95% CI, 0.06-0.07) were protective factors for menstrual poverty. Besides, 75.2% reported having overused menstrual products due to lack of access to adequate menstrual management facilities. Menstrual-related discrimination was reported by 44.5% of the participants. Non-binary participants (aOR: 1.88, 95% CI, 1.52-2.33) and those who did not have a permit to reside in Spain (aOR: 2.11, 95% CI, 1.10-4.03) had higher odds of reporting menstrual-related discrimination. Work and education absenteeism were reported by 20.3% and 62.7% of the participants, respectively. CONCLUSIONS Our study suggests that menstrual inequities affect a high number of women and PWM in Spain, especially those more socioeconomically deprived, vulnerabilised migrant populations and non-binary and trans menstruators. Findings from this study can be valuable to inform future research and menstrual inequity policies.
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Affiliation(s)
- Laura Medina-Perucha
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gran Via de Les Corts Catalanes 587 Attic, 08007, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.
| | - Tomàs López-Jiménez
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gran Via de Les Corts Catalanes 587 Attic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gran Via de Les Corts Catalanes 587 Attic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Anna Sofie Holst
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gran Via de Les Corts Catalanes 587 Attic, 08007, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Jordina Munrós-Feliu
- Atenció a La Salut Sexual I Reproductiva (ASSIR) Muntanya/La Mina, Institut Català de La Salut, Barcelona, Spain
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
| | - Cristina Martínez-Bueno
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
- Servei d'Atenció a La Salut Sexual I Reproductiva (ASSIR). Direcció Assistencial d'Atenció Primària. Institut Català de La Salut, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | | | | | - Anna Berenguera
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Gran Via de Les Corts Catalanes 587 Attic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Departament d'Infermeria, Universitat de Girona, Girona, Spain
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14
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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] [MESH Headings] [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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Erku D, Khatri R, Endalamaw A, Wolka E, Nigatu F, Zewdie A, Assefa Y. Community engagement initiatives in primary health care to achieve universal health coverage: A realist synthesis of scoping review. PLoS One 2023; 18:e0285222. [PMID: 37134102 PMCID: PMC10156058 DOI: 10.1371/journal.pone.0285222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/17/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Community engagement (CE) is an essential component in a primary health care (PHC) and there have been growing calls for service providers to seek greater CE in the planning, design, delivery and evaluation of PHC services. This scoping review aimed to explore the underlying attributes, contexts and mechanisms in which community engagement initiatives contribute to improved PHC service delivery and the realisation of UHC. METHODS PubMed, PsycINFO, CINAHL, Cochrane Library, EMBASE and Google Scholar were searched from the inception of each database until May 2022 for studies that described the structure, process, and outcomes of CE interventions implemented in PHC settings. We included qualitative and quantitative studies, process evaluations and systematic or scoping reviews. Data were extracted using a predefined extraction sheet, and the quality of reporting of included studies was assessed using the Mixed Methods Appraisal Tool. The Donabedian's model for quality of healthcare was used to categorise attributes of CE into "structure", "process" and "outcome". RESULTS Themes related to the structural aspects of CE initiatives included the methodological approaches (i.e., format and composition), levels of CE (i.e., extent, time, and timing of engagement) and the support processes and strategies (i.e., skills and capacity) that are put in place to enable both communities and service providers to undertake successful CE. Process aspects of CE initiatives discussed in the literature included: i) the role of the community in defining priorities and setting objectives for CE, ii) types and dynamics of the broad range of engagement approaches and activities, and iii) presence of an on-going communication and two-way information sharing. Key CE components and contextual factors that affected the impact of CE initiatives included the wider socio-economic context, power dynamics and representation of communities and their voices, and cultural and organisational issues. CONCLUSIONS Our review highlighted the potential role of CE initiatives in improving decision making process and improving overall health outcomes, and identified several organisational, cultural, political, and contextual factors that affect the success of CE initiatives in PHC settings. Awareness of and responding to the contextual factors will increase the chances of successful CE initiatives.
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Affiliation(s)
- Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, SouthPort, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, SouthPort, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Resham Khatri
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Sory O, Kiendrébéogo JA, Kafando Y, Kaboré I, Tapsoba C, Kaboré S, Mbaye S, Touré C. The role and contribution of civil society and community actors in COVID-19 prevention and control: the case of the COMVID COVID-19 movement in Burkina Faso. BMJ Glob Health 2023; 8:bmjgh-2022-011508. [PMID: 37028812 PMCID: PMC10083517 DOI: 10.1136/bmjgh-2022-011508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/07/2023] [Indexed: 04/09/2023] Open
Abstract
Communities should play a crucial role in the fight against public health emergencies but ensuring their effective and sustained engagement remains a challenge in many countries. In this article, we describe the process of mobilising community actors to contribute to the fight against COVID-19 in Burkina Faso. During the early days of the pandemic, the national COVID-19 response plan called for the involvement of community actors, but no strategy had been defined for this purpose. The initiative to involve community actors in the fight against COVID-19 was taken, independently of the government, by 23 civil society organisations gathered through a platform called 'Health Democracy and Citizen Involvement (DES-ICI)'. In April 2020, this platform launched the movement 'Communities are committed to Eradicate COVID-19 (COMVID COVID-19)' which mobilised community-based associations organised into 54 citizen health watch units (CCVS) in Ouagadougou city. These CCVS worked as volunteers, performing door-to-door awareness campaigns. The psychosis created by the pandemic, the proximity of civil society organisations to the communities and the involvement of religious, customary and civil authorities facilitated the expansion of the movement. Given the innovative and promising nature of these initiatives, the movement gained recognition that earned them a seat on the national COVID-19 response plan. This gave them credibility in the eyes of the national and international donors, thus facilitating the mobilisation of resources for the continuity of their activities. However, the decrease in financial resources to offset the community mobilisers gradually reduced the enthusiasm for the movement. In a nutshell, the COMVID COVID-19 movement fostered dialogues and collaboration among civil society, community actors and the Ministry of Health, which plans to engage the CCVS beyond the COVID-19 response, for the implementation of other actions within the national community health policy.
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Affiliation(s)
- Orokia Sory
- Recherche pour la Santé et le Développement (RESADE), Ouagadougou, Burkina Faso
| | - Joël Arthur Kiendrébéogo
- Department of Public Health, Universite Joseph Ki-Zerbo Unite de Formation et de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Yamba Kafando
- Recherche pour la Santé et le Développement (RESADE), Ouagadougou, Burkina Faso
| | - Issa Kaboré
- Recherche pour la Santé et le Développement (RESADE), Ouagadougou, Burkina Faso
| | - Charlemagne Tapsoba
- Recherche pour la Santé et le Développement (RESADE), Ouagadougou, Burkina Faso
- Centre de Recherche en Santé de Nouna (CRSN), Ouagadougou, Burkina Faso
| | - Simon Kaboré
- Réseau Accès aux Médicaments Essentiels (RAME), Ouagadougou, Burkina Faso
| | - Seyni Mbaye
- Results for Development Institute, Dakar, Senegal
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Mannell J, Washington L, Khaula S, Khoza Z, Mkhwanazi S, Burgess RA, Brown LJ, Jewkes R, Shai N, Willan S, Gibbs A. Challenges and opportunities in coproduction: reflections on working with young people to develop an intervention to prevent violence in informal settlements in South Africa. BMJ Glob Health 2023; 8:e011463. [PMID: 36990642 PMCID: PMC10069549 DOI: 10.1136/bmjgh-2022-011463] [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: 12/07/2022] [Accepted: 03/09/2023] [Indexed: 03/31/2023] Open
Abstract
Coproduction is widely recognised as essential to the development of effective and sustainable complex health interventions. Through involving potential end users in the design of interventions, coproduction provides a means of challenging power relations and ensuring the intervention being implemented accurately reflects lived experiences. Yet, how do we ensure that coproduction delivers on this promise? What methods or techniques can we use to challenge power relations and ensure interventions are both more effective and sustainable in the longer term? To answer these questions, we openly reflect on the coproduction process used as part of Siyaphambili Youth ('Youth Moving Forward'), a 3-year project to create an intervention to address the social contextual factors that create syndemics of health risks for young people living in informal settlements in KwaZulu-Natal province in South Africa. We identify four methods or techniques that may help improve the methodological practice of coproduction: (1) building trust through small group work with similar individuals, opportunities for distance from the research topic and mutual exchanges about lived experiences; (2) strengthening research capacity by involving end users in the interpretation of data and explaining research concepts in a way that is meaningful to them; (3) embracing conflicts that arise between researchers' perspectives and those of people with lived experiences; and (4) challenging research epistemologies through creating spaces for constant reflection by the research team. These methods are not a magic chalice of codeveloping complex health interventions, but rather an invitation for a wider conversation that moves beyond a set of principles to interrogate what works in coproduction practice. In order to move the conversation forward, we suggest that coproduction needs to be seen as its own complex intervention, with research teams as potential beneficiaries.
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Affiliation(s)
| | | | | | | | - Smanga Mkhwanazi
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Rochelle A Burgess
- Institute for Global Health, University College London, London, UK
- Department of Social Work, University of Johannesburg, Auckland Park, South Africa
| | - Laura J Brown
- Institute for Global Health, University College London, London, UK
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa
| | - Nwabisa Shai
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Samantha Willan
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Psychology, University of Exeter, Exeter, UK
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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:e009423. [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] [MESH Headings] [Grants] [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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Pappu NI, Öberg I, Byrskog U, Raha P, Moni R, Akhtar S, Barua P, Das SR, De S, Jyoti HJ, Rahman R, Sinha GR, Erlandsson K. The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students. PLoS One 2023; 18:e0271867. [PMID: 37036838 PMCID: PMC10085017 DOI: 10.1371/journal.pone.0271867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services. METHODS Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh. RESULTS One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories. CONCLUSION The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.
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Affiliation(s)
| | - Ida Öberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ulrika Byrskog
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Pronita Raha
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ratna Moni
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Shaheen Akhtar
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Priti Barua
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Sujata Rani Das
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Shipra De
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Rezaur Rahman
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Gita Rani Sinha
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Belaid L, Sarmiento I, Dimiti A, Andersson N. Community Participation in Primary Healthcare in the South Sudan Boma Health Initiative: A Document Analysis. Int J Health Policy Manag 2022; 11:2869-2875. [PMID: 35418007 PMCID: PMC10105198 DOI: 10.34172/ijhpm.2022.6639] [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: 07/21/2021] [Accepted: 03/27/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Community participation is central to primary healthcare, yet there is little evidence of how this works in conflict settings. In 2016, South Sudan's Ministry of Health launched the Boma Health Initiative (BHI) to improve primary care services through community participation. METHODS We conducted a document analysis to examine how well the BHI policy addressed community participation in its policy formulation. We reviewed other policy documents and published literature to provide background context and supplementary data. We used a deductive thematic analysis that followed Rifkin and colleagues' community participation framework to assess the BHI policy. RESULTS The BHI planners included inputs from communities without details on how the needs assessment was conducted at the community level, what needs were considered, and from which community. The intended role of communities was to implement the policy under local leadership. There was no information on how the Initiative might strengthen or expand local women's leadership. Official documents did not contemplate local power relations or address gender imbalance. The policy approached households as consumers of health services. CONCLUSION Although the BHI advocated community participation to generate awareness, increase acceptability, access to services and ownership, the policy document did not include community participation during policy cycle.
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Affiliation(s)
- Loubna Belaid
- CIET-PRAM (Participatory Research at McGill), Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Iván Sarmiento
- CIET-PRAM (Participatory Research at McGill), Department of Family Medicine, McGill University, Montreal, QC, Canada
- Grupo de Estudios en Sistemas Tradicionales de Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alexander Dimiti
- Department of Reproductive Health, Ministry of Health, Juba, South Sudan
| | - Neil Andersson
- CIET-PRAM (Participatory Research at McGill), Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Pare Toe L, Dicko B, Linga R, Barry N, Drabo M, Sykes N, Thizy D. Operationalizing stakeholder engagement for gene drive research in malaria elimination in Africa—translating guidance into practice. Malar J 2022; 21:225. [PMID: 35870909 PMCID: PMC9308116 DOI: 10.1186/s12936-022-04241-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractGene drive mosquitoes are increasingly considered a potential transformational tool for vector control of malaria mosquitoes. As part of efforts to promote responsible research in this field, a number of guidance documents have been published by the World Health Organization, National Academies and expert groups. While virtually all recent guidance documents on gene drive research stress the importance of stakeholder engagement activities, no specific guidelines on implementing them have been established. Target Malaria, a not-for-profit research consortium developing a vector-control gene drive approach to eliminate malaria, has reflected on how its stakeholder engagement strategy translates engagement guidance documents into practice. The project analysed and addressed the tension between the context specificities and the international recommendations. The engagement strategy combines published recommendations for responsible gene drive research, information collected from the local context where the project operates and a set of principles guiding the choices made. This strategy was first developed during the early phases of the project’s research, years ahead of any activities with gene drive mosquitoes in those countries of operations. These earlier activities, and their related engagement, allow the project to develop and adapt an engagement strategy appropriate for potential gene drive research in its field site countries. This paper offers a description of a stakeholder engagement strategy operationalization based on (1) adaptation to stakeholder preferences, (2) inclusiveness and (3) empowerment and accountability. The authors hope to offer concrete examples to support other projects with the development and implementation of their engagement strategies with particular attention to the co-development principle.
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Caperon L, Saville F, Ahern S. Developing a socio-ecological model for community engagement in a health programme in an underserved urban area. PLoS One 2022; 17:e0275092. [PMID: 36155664 PMCID: PMC9512167 DOI: 10.1371/journal.pone.0275092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/11/2022] [Indexed: 11/18/2022] Open
Abstract
Despite a recent increase in community engagement in health initiatives during the COVID-19 pandemic, health inequalities and health inequities remain a serious problem for society, often affecting those in underserved communities the most. Often individualised incentives such as payment for vaccinations have been used to increase involvement in health initiatives but evidence suggests that these do not always work and can be ineffective. This paper addresses the real world problem of a lack of involvement of communities in health programmes and subsequent health inequalities. Using data from nine workshops with community members evaluating a large community health programme, we develop a socio-ecological model [SEM] of influences on community engagement in health programmes to identify holistic and systemic barriers and enablers to such engagement. To date SEM has not been used to develop solutions to improve community engagement in health programmes. Such an approach holds the potential to look beyond individualised conceptualisations of behaviour and instead consider a multitude of social and cultural influences. This knowledge can then be used to develop multi-faceted and multi-layered solutions to tackle the barriers to community engagement in health programmes. Our SEM highlights the overarching importance of the socio-cultural environment in influencing community engagement. Within the socio-cultural environment were factors such as trust, social support and community mindedness. We also found that other factors affecting community engagement fall within individual, economic, technological, political and physical environments. Such factors include engagement in community organisation governance and processes, access to and ability to use technology and access to safe outdoor spaces. We propose further testing our socioecological model in other communities.
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Affiliation(s)
- Lizzie Caperon
- Bradford Institute for Health Research, Bradford, United Kingdom
- * E-mail:
| | - Fiona Saville
- Better Start Bradford, Mayfield Centre, Bradford, United Kingdom
| | - Sara Ahern
- Bradford Institute for Health Research, Bradford, United Kingdom
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Robert RC, Feijoo BL. Beneficiary and Local Stakeholder Participation in Community-Based Nutrition Interventions. Curr Dev Nutr 2022; 6:nzac131. [PMID: 36157848 PMCID: PMC9492256 DOI: 10.1093/cdn/nzac131] [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: 10/01/2021] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Beneficiary and local stakeholder participation is an essential element to the success of community-based nutrition interventions. We sought to define active participation and review the available evidence on beneficiary and local stakeholder participation in community-based nutrition interventions in Africa. From reviewing the literature, we provide a reflective assessment on the process and findings. Participation falls on a continuum of community involvement from passive (no real involvement) to empowerment and community ownership (full active involvement). However, we found a clear gap in the research on defining active participation and identifying what constitutes active participation on behalf of beneficiaries and local stakeholders. However, progress was found; evidence included the use of participatory methods to engage beneficiaries and local stakeholders in the assessment and design phase. Beneficiary and local stakeholder participation in delivering interventions has moved forward with quantitative measures from process evaluation and implementation science. Research has started on the extent of beneficiary engagement (as recipients) and connecting this to outcomes. Evaluation has benefited from qualitative inquiry with insights from participants on engagement itself, and the barriers and facilitators to engagement. Yet questions remain in each study phase around defining and quantifying active participation and in understanding the personal, social, and motivational elements of active participation. We offer a simple framework to stimulate thought and commitment to research on participation in community-based nutrition interventions.
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Affiliation(s)
- Rebecca C Robert
- Conway School of Nursing, The Catholic University of America, Washington, DC, USA
| | - Brittany L Feijoo
- Conway School of Nursing, The Catholic University of America, Washington, DC, USA
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Thomas S, Sivaram S, Shroff Z, Mahal A, Desai S. 'We are the bridge': an implementation research study of SEWA Shakti Kendras to improve community engagement in publicly funded health insurance in Gujarat, India. BMJ Glob Health 2022; 7:e008888. [PMID: 36379589 PMCID: PMC9511541 DOI: 10.1136/bmjgh-2022-008888] [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] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION India's efforts towards universal health coverage include a national health insurance scheme that aims to protect the most vulnerable from catastrophic health expenditure. However, emerging evidence on publicly funded health insurance, as well as experience from community-based schemes, indicates that women face specific barriers to access and utilisation. Community engagement interventions have been shown to improve equitable utilisation of public health services, but there is limited research specific to health insurance. We examined how existing community-based resource centres implemented by a women's organisation could improve women's access to, and utilisation of, health insurance. METHODS We conducted an implementation research study in Gujarat, India to examine how SEWA Shakti Kendras, established by the Self-Employed Women's Association, worked to improve community engagement in health insurance. SEWA organises women in the informal sector and provides social protection through health, insurance and childcare services. We examined administrative data, programme reports and conducted 30 in-depth qualitative interviews with users and staff. Data were analysed thematically to examine intervention content, context, and implementation processes and to identify enablers and barriers to improving women's access to health insurance through SEWA's community engagement approach. RESULTS The centres worked through multiple channels-doorstep services, centre-based support and health system navigation-to strengthen women's capability to access health insurance. Each centre's approach varied by contextual factors, such as women's digital literacy levels and rural-urban settings. Effective community engagement required local leadership, strong government partnerships and the flexibility to address a range of public services, with implementation by trusted local health workers. CONCLUSION SEWA Shakti Kendras demonstrate how a local, flexible and community-based model can serve as a bridge to improve utilisation of health insurance, by engaging women and their households through multiple channels. Scaling up this approach will require investing in partnerships with community-based organisations as part of strategies towards universal health coverage.
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Affiliation(s)
- Susan Thomas
- Lok Swasthya SEWA Trust, Self-Employed Women's Association (SEWA), Ahmedabad, Gujarat, India
| | | | - Zubin Shroff
- Alliance For Health Policy and System Research, Geneva, Switzerland
| | - Ajay Mahal
- The University of Melbourne Nossal Institute for Global Health, Carlton, Victoria, Australia
| | - Sapna Desai
- Population Council Institute, New Delhi, India
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Evaluation of community-based participatory governance interventions to improve access to health-related public entitlements in India. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2022. [DOI: 10.1108/ijhg-03-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeAs the investment in social and health protection remained poor in India, the most vulnerable citizens lack access to existing health related government initiatives with transformational benefits due mostly to the lack of “accurate information”. The purpose of this paper is to explore and demonstrate the impact of participation of the community through a structured intervention that promotes awareness, enables the community to ensure entitlements, and enhances the utilization of government initiatives.Design/methodology/approachThrough a baseline–endline study using a quasi-experimental design, this research provides empirical evidence of such intervention on awareness and utilization of health, nutrition and developmental initiatives. It involved survey of 400 households from the four study locations before and after the interventions. The pre-post estimation in the “proportion of respondents who were fully aware” was analyzed to measure changes in knowledge. Mc-Nemar test was applied to measure the statistical significance of these changes.FindingsThe results indicate that the intervention of “empowerment centers” has increased knowledge and utilization of the various government schemes, services and facilities that are routine and offer benefits all household members, in general, and women as well as children, in particular. The intervention was found to be successful in improving the local governance systems; empowering communities, linking communities and local level government systems across all sectors, as well as bringing in inter-sectoral linkages across governments systems.Research limitations/implicationsAlthough there have been many interventions of community participation for reducing inequities across the globe, there is a dearth of documentation and evidence generation. More efforts are required to evaluate such interventions, identify which interventions work and how they can be adapted to different contexts. This also requires exploration of the social processes and contextual realities underlying these interventions.Originality/valueTo the best knowledge of the authors, this research is one-of-its-kind that assessed an intervention targeting cross-cutting schemes and services, beyond just health interventions. The evidence points to the success of grassroots level inter-sectoral community actions, in the form of empowerment centers, to improve awareness and utilization of government interventions through participatory governance, and points to the expanding scope of learning and adapting such interventions to different contexts and scopes.
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Building social accountability to improve reproductive, maternal, newborn and child health in Nigeria. Int J Equity Health 2022; 21:46. [PMID: 35392914 PMCID: PMC8988322 DOI: 10.1186/s12939-022-01643-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Like many places in Nigeria, Niger, a predominantly rural and poor state in the north of the country, has high fertility, low contraceptive prevalence, and high maternal mortality. This paper presents a descriptive, contextualized case study of a social accountability campaign run by the nongovernmental organization White Ribbon Alliance Nigeria to strategically mobilize collective action to demand quality maternal health care and improve government responsiveness to those demands. We treat maternal health as a component of reproductive health, while recognizing it as a less contested area. Methods Data come from more than 40 interviews with relevant actors in Niger State in 2017 and 2018 during the initial phase of the campaign, and follow-up interviews with White Ribbon Alliance Nigeria staff in 2019 and 2021. Other data include White Ribbon Alliance Nigeria’s monthly reports. We analyzed these data both deductively and inductively using qualitative techniques. Results During its first phase, the campaign used advocacy techniques to convince the previously reticent state government to engage with citizens, and worked to amplify citizen voice by hosting community dialogues and town halls, training a cadre of citizen journalists, and shoring up ward health development committees. Many of these efforts were unsustainable, however, so during the campaign’s second phase, White Ribbon Alliance Nigeria worked to solidify state commitment to durable accountability structures intended to survive beyond the campaign’s involvement. Key challenges have included a nontransparent state budget release process and the continued need for significant support from White Ribbon Alliance Nigeria. Conclusion These findings reveal the significant time and resource inputs associated with implementing a strategic social accountability campaign, important compromises around the terminology used to describe “accountability,” and the constraints on government responsiveness posed by unrealistic budgeting procedures. The campaign’s contributions towards increased social accountability for maternal health should, however, also benefit accountability for reproductive health, as informed and empowered woman are better prepared to demand health services in any sector.
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Karuga R, Kok M, Luitjens M, Mbindyo P, Broerse JEW, Dieleman M. Participation in primary health care through community-level health committees in Sub-Saharan Africa: a qualitative synthesis. BMC Public Health 2022; 22:359. [PMID: 35183154 PMCID: PMC8858504 DOI: 10.1186/s12889-022-12730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Health committees are key mechanisms for enabling participation of community members in decision-making on matters related to their health. This paper aims to establish an in-depth understanding of how community members participate in primary health care through health committees in sub-Saharan Africa (SSA). Methods We searched peer-reviewed English articles published between 2010 and 2019 in MEDLINE, Popline and CINAHL databases. Articles were eligible if they involved health committees in SSA. Our search yielded 279 articles and 7 duplicates were removed. We further excluded 255 articles following a review of titles and abstracts by two authors. Seventeen abstracts were eligible for full text review. After reviewing the full-text, we further excluded two articles that did not explicitly describe the role of health committees in community participation. We therefore included 15 articles in this review. Two authors extracted data on how health committees contributed to community participation in SSA using a conceptual framework for assessing community participation in health. We derived our themes from five process indicators in this framework, namely, leadership, management and planning, resource mobilization from external sources, monitoring and evaluation and women involvement. Findings We found that health committees work well in voicing communities’ concerns about the quality of care provided by health facility staff, day-to-day management of health facilities and mobilizing financial and non-financial resources for health activities and projects. Health committees held health workers accountable by monitoring absenteeism, quality of services and expenditures in health facilities. Health committees lacked legitimacy because selection procedures were often not transparent and participatory. Committee members were left out in planning and budgeting processes by health workers, who perceived them as insufficiently educated and trained to take part in planning. Most health committees were male-dominated, thus limiting participation by women. Conclusion Health committees contribute to community participation through holding primary health workers accountable, voicing their communities’ concern and mobilizing resources for health activities and projects. Decision makers, health managers and advocates need to fundamentally rethink how health committees are selected, empowered and supported to implement their roles and responsibilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12730-y.
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Lowery CM, Craig HC, Litvin K, Dickin KL, Stein M, Worku B, Martin SL. Experiences Engaging Family Members in Maternal, Child, and Adolescent Nutrition: A Survey of Global Health Professionals. Curr Dev Nutr 2022; 6:nzac003. [PMID: 35224418 PMCID: PMC8866103 DOI: 10.1093/cdn/nzac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/17/2021] [Accepted: 01/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Family members influence maternal, child, and adolescent nutrition and are increasingly engaged in nutrition interventions and research. However, there remain gaps in the literature related to programmatic experiences and lessons learned from engaging these key influencers in nutrition activities. OBJECTIVES This research aimed to document global health professionals' experiences engaging family members in nutrition activities, and their perceived barriers, facilitators, and recommendations for nutrition activities that engage family members. METHODS Global health and nutrition professionals were invited to complete an online survey about their experiences engaging family members in nutrition activities. The survey included 42 multiple-choice questions tabulated by frequency and 4 open-response questions, which were analyzed thematically. RESULTS More than 180 respondents (n = 183) in 49 countries with experience engaging fathers, grandmothers, and other family members in nutrition activities participated in the survey. Participants highlighted the importance of conducting formative research with all members of the family system and using participatory processes in intervention design and implementation. Respondents reported engaging family members increases support for recommended behaviors, improves program sustainability, and facilitates family and community ownership. Some respondents also shared experiences with positive and negative unintended consequences when engaging family members; for example, one-fifth of participants reported that mothers were uncomfortable with involving men in discussions. Common challenges centered on limited resources for program delivery, not involving all influential family members, and traditional gender norms. Recommendations included incorporating family members in the project design phase and ensuring sufficient project resources to engage family members throughout the project lifecycle. CONCLUSIONS Surveying global health professionals provides an opportunity to learn from their experiences and fill gaps in the peer-reviewed literature to strengthen intervention design and implementation. Community ownership and sustainability emerged as key benefits of family engagement not previously reported in the literature, but responses also highlighted potential negative unintended consequences.
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Affiliation(s)
- Caitlin M Lowery
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hope C Craig
- Master of Public Health Program, Population Medicine & Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Kate Litvin
- USAID Advancing Nutrition, Arlington, VA, USA
| | - Katherine L Dickin
- Master of Public Health Program, Population Medicine & Diagnostic Sciences, Cornell University, Ithaca, NY, USA
- USAID Advancing Nutrition, Arlington, VA, USA
| | - Maggie Stein
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beamlak Worku
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Babu BV, Kusuma YS, Sivakami M, Lal DK, Geddam JB, Khanna A, Agarwal M, Sudhakar G, Sengupta P, Kerketta AS, Sharma Y. Inclusive partnership and community mobilization approaches to improve maternal health care access among internal migrants in nine Indian cities. J Migr Health 2022; 6:100130. [PMID: 36110500 PMCID: PMC9467881 DOI: 10.1016/j.jmh.2022.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 05/17/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Disparities in healthcare access to internal migrants exist, and the gaps may widen further if appropriate steps are not taken. Innovative approaches are needed to better align the healthcare services with the migrants’ needs. Aim The aim was to develop and test a supportive strategy of healthcare, which would achieve the desired level of access and delivery of maternal healthcare services to internal migrants living in nine Indian cities. Methods This intervention with the quasi-experimental design was conducted with pre- vs post-intervention comparisons within the interventional groups and with the control group. The intervention was implemented with an inclusive partnership approach. Advocacy and community mobilization were the main intervention components. Findings An increased proportion of women sought antenatal care during the intervention. More women initiated seeking antenatal care in the first trimester. Due to intervention, health workers’ prenatal (41.7% in the post- against 14.7% in the pre-interventional phase) and postnatal home visits increased (11.6% to 34.7%) considerably. Conclusions Interventions with inclusive partnership would improve healthcare access to vulnerable communities such as migrants. Hence, efforts to strengthen the government healthcare system through novel strategies are crucial to provide better healthcare to migrants.
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Schoch-Spana M, Brunson EK, Long R, Ruth A, Ravi SJ, Trotochaud M, Borio L, Brewer J, Buccina J, Connell N, Hall LL, Kass N, Kirkland A, Koonin L, Larson H, Lu BF, Omer SB, Orenstein WA, Poland GA, Privor-Dumm L, Quinn SC, Salmon D, White A. The public's role in COVID-19 vaccination: Human-centered recommendations to enhance pandemic vaccine awareness, access, and acceptance in the United States. Vaccine 2021; 39:6004-6012. [PMID: 33160755 PMCID: PMC7598529 DOI: 10.1016/j.vaccine.2020.10.059] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
Given the social and economic upheavals caused by the COVID-19 pandemic, political leaders, health officials, and members of the public are eager for solutions. One of the most promising, if they can be successfully developed, is vaccines. While the technological development of such countermeasures is currently underway, a key social gap remains. Past experience in routine and crisis contexts demonstrates that uptake of vaccines is more complicated than simply making the technology available. Vaccine uptake, and especially the widespread acceptance of vaccines, is a social endeavor that requires consideration of human factors. To provide a starting place for this critical component of a future COVID-19 vaccination campaign in the United States, the 23-person Working Group on Readying Populations for COVID-19 Vaccines was formed. One outcome of this group is a synthesis of the major challenges and opportunities associated with a future COVID-19 vaccination campaign and empirically-informed recommendations to advance public understanding of, access to, and acceptance of vaccines that protect against SARS-CoV-2. While not inclusive of all possible steps than could or should be done to facilitate COVID-19 vaccination, the working group believes that the recommendations provided are essential for a successful vaccination program.
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Affiliation(s)
- Monica Schoch-Spana
- Johns Hopkins Center for Health Security, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Emily K Brunson
- Department of Anthropology, Texas State University, San Marcos, TX, USA
| | - Rex Long
- Department of Anthropology, Texas State University, San Marcos, TX, USA
| | - Alexandra Ruth
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Sustainable Health Care Quality and Equity, Washington, DC, USA
| | - Sanjana J Ravi
- Johns Hopkins Center for Health Security, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marc Trotochaud
- Johns Hopkins Center for Health Security, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Janesse Brewer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Nancy Connell
- Johns Hopkins Center for Health Security, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura Lee Hall
- Center for Sustainable Health Care Quality and Equity, Washington, DC, USA
| | - Nancy Kass
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Anna Kirkland
- Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Lisa Koonin
- Health Preparedness Partners, Atlanta, GA, USA
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Brooke Fisher Lu
- Department of Communication, University of Maryland, College Park, MD, USA
| | - Saad B Omer
- Yale Institute for Global Health, New Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA; Yale School of Public Health, New Haven, CT, USA
| | - Walter A Orenstein
- Emory Vaccine Center, Atlanta, GA, USA; Emory School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, USA
| | - Lois Privor-Dumm
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Daniel Salmon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandre White
- Department of The History of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center for Medical Humanities and Social Medicine, Johns Hopkins University, Baltimore, MD, USA
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Von Heimburg D, Ness O. Relational welfare: a socially just response to co-creating health and wellbeing for all. Scand J Public Health 2021; 49:639-652. [PMID: 33323094 PMCID: PMC8512264 DOI: 10.1177/1403494820970815] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
AIMS Contemporary approaches to pursuing public value and the vision of health and wellbeing for all have evolved notably in the past few decades, with distinct approaches termed 'co-creation' and 'health promotion' gaining traction. This article explores a critique of ongoing paradigmatic shifts in public health and the public sector, focusing on cross-fertilisation between co-creation and the promotion of health and wellbeing. Drawing on Nancy Fraser's claims for social justice through redistribution, recognition and representation to achieve participatory parity, we discuss a need for transformative change to achieve societal goals of creating health and wellbeing for all, leaving no one behind. CONCLUSIONS Health promotion and co-creation converge in a quest for active citizenship through participation, as well as embracing a whole-of-government and whole-of-society approach. However, inequity in such processes, as well as health and wellbeing outcomes, are still persistent and contradictory to health promotion aims. This article argues that radically attending to human relationships and our dependency on other humans as a 'collective' need to be placed at the core of future-forming social construction of public and democratic institutions to allow the ongoing cross-fertilisation between health promotion and co-creation to work. Responding to this calls for transformation, the article presents a framework for developing a relational approach to welfare. The framework advocates for 'relational welfare', which captures the intersection of the welfare state, democracy and human relationships attending to social justice, capabilities and health and wellbeing for all as key public values in societal development.
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Affiliation(s)
| | - Ottar Ness
- Department of Education and Lifelong
Learning, Norwegian University of Science and Technology, Trondheim, Norway
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Hoodbhoy Z, Sheikh SS, Qureshi R, Memon J, Raza F, Kinshella MLW, Bone JN, Vidler M, Sharma S, Payne BA, Magee LA, von Dadelszen P, Bhutta ZA. Role of community engagement in maternal health in rural Pakistan: Findings from the CLIP randomized trial. J Glob Health 2021; 11:04045. [PMID: 34326995 PMCID: PMC8285765 DOI: 10.7189/jogh.11.04045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Community-based strategies to promote maternal health can help raise awareness of pregnancy danger signs and preparations for emergencies. The objective of this study was to assess change in birth preparedness and complication readiness (BPCR) and pregnant women’s knowledge about pre-eclampsia as part of community engagement (CE) activities in rural Pakistan during the Community Level Interventions for Pre-eclampsia (CLIP) Trial. Methods The CLIP Trial was a cluster randomized controlled trial that aimed to reduce maternal and perinatal morbidity and mortality using CE strategies alongside mobile health-supported care by community health care providers. CE activities engaged pregnant women at their homes and male stakeholders through village meetings in Hyderabad and Matiari in Sindh, Pakistan. These sessions covered pregnancy complications, particularly pre-eclampsia/eclampsia, BPCR and details of the CLIP intervention package. BPCR was assessed using questions related to transport arrangement, permission for care, emergency funds, and choice of facility birth attendant for delivery during quarterly household surveys. Outcomes were assessed via multilevel logistic regression with adjustment for relevant confounders with effects summarized as odds ratios and 95% confidence intervals. Results There were 15 137 home-based CE sessions with pregnant women and families (n = 46 614) and 695 village meetings with male stakeholders (n = 7784) over two years. The composite outcomes for BPCR and pre-eclampsia knowledge did not differ significantly between trial arms. However, CE activities were associated with improved pre-eclampsia knowledge in some areas. Specifically, pregnant women in the intervention clusters were twice as likely to know that seizures could be a complication of pregnancy (odds ratio (OR) = 2.17, 95% confidence interval (CI) = 1.11, 4.23) and 2.5 times more likely to know that high blood pressure is potentially life-threatening during pregnancy (OR = 2.52, 95% CI = 1.31, 4.83) vs control clusters. Conclusions The findings suggested that a CE strategy for male and female community stakeholders increased some measures of knowledge regarding complications of pre-eclampsia in low-resource settings. However, the effect of this intervention on long-term health outcomes needs further study. Trial registration Clinical Trials.gov – INCT01911494.
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Affiliation(s)
- Zahra Hoodbhoy
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Sana Sadiq Sheikh
- Department of Obstetrics and Gynecology, The Aga Khan University, Karachi, Pakistan
| | - Rahat Qureshi
- Department of Obstetrics and Gynecology, The Aga Khan University, Karachi, Pakistan
| | - Javed Memon
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Farrukh Raza
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey N Bone
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Marianne Vidler
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Sumedha Sharma
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Beth A Payne
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Laura A Magee
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, London, UK
| | - Peter von Dadelszen
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, London, UK
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan and East Africa, Karachi, Pakistan.,Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
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Heimburg DV, Cluley V. Advancing complexity-informed health promotion: a scoping review to link health promotion and co-creation. Health Promot Int 2021; 36:581-600. [PMID: 32810227 DOI: 10.1093/heapro/daaa063] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A complexity-informed approach has recently been proposed as a hopeful revolution for health promotion (HP), requesting appropriate ways of tackling the complexities of health, equity and well-being. In addition, co-creation has gained traction as an approach to tackle complexity. HP and co-creation are established concepts that have long been enacted in practice. Although each concept is premised on similar approaches to value-creation such as participation and collaboration, little has been done to link the two approaches. To advance complexity-informed HP, this scoping review presents findings from peer-reviewed articles, published in English, between 2009 and March 2020. Articles were identified through searches of academic databases. Twenty-seven articles met the inclusion criteria, explicitly linking HP and co-creation. Included articles were charted by descriptive information and main focus, and advanced by a thematic analysis. Four themes suggest a potential avenue for advancing complexity-informed HP: (i) dealing with complexity, (ii) value creation, (iii) the value of the values and (iv) benefits and challenges. While current links between HP and co-creation are scarce they are increasing and promising. Based on the findings from the review, propositions to advance complexity-informed HP is outlined and discussed. Overall it is argued that co-creation and HP are mutually beneficial concepts, providing a framework for participative, collaborative, context-sensitive and knowledge-based practice that reflects the complex nature of health. More research is needed to highlight potential and challenges of integrating co-creation in HP, especially related to health equity and sustainable development.
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Affiliation(s)
- Dina von Heimburg
- Faculty of Social Sciences, Nord University, PO Box 1490, 8049 Bodø, Norway
| | - Victoria Cluley
- Cass Business School, City, University of London, 108 Bunhill Row, London, EC1Y 8TZ
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Lasco G, Mendoza J, Renedo A, Seguin ML, Palafox B, Palileo-Villanueva LM, Amit AML, Dans AL, Balabanova D, McKee M. Nasa dugo ('It's in the blood'): lay conceptions of hypertension in the Philippines. BMJ Glob Health 2021; 5:bmjgh-2020-002295. [PMID: 32646854 PMCID: PMC7351273 DOI: 10.1136/bmjgh-2020-002295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Understanding explanatory models is important for hypertension, a leading risk factor for cardiovascular disease and stroke. This article aims to determine what adult patients with hypertension in the Philippines attribute their condition to, how these views might be explained and what the implications are for hypertension management. Methods This is a qualitative study drawing on 71 semistructured interviews (40 initial and 31 follow-up) and four focus group discussions with patients diagnosed with hypertension. The setting was urban and rural low-income communities in the Philippines. Results Four prominent perceived causes were identified—genetics, heat, stress and diet—for what patients refer to as ‘high blood’. We propose a ‘folk physiology’ that rests on local understandings of blood and blood flow, draws from broader cultural notions of illness causation and accounts for a dynamic, non-chronic view of hypertension that in turn informs the health behaviours of those affected. Conclusions By understanding that hypertension is frequently seen not as a chronic constant condition but rather as an episodic one triggered by external influences, although in those genetically predisposed to it, it may be possible to address patient’s beliefs and thus adherence to treatment.
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Affiliation(s)
- Gideon Lasco
- Department of Anthropology, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines .,Development Studies Program, Ateneo de Manila University, Quezon City, Philippines
| | - Jhaki Mendoza
- Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Alicia Renedo
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Antonio L Dans
- Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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Spencer J, Gilmore B, Lodenstein E, Portela A. A mapping and synthesis of tools for stakeholder and community engagement in quality improvement initiatives for reproductive, maternal, newborn, child and adolescent health. Health Expect 2021; 24:744-756. [PMID: 33794046 PMCID: PMC8235899 DOI: 10.1111/hex.13237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/24/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stakeholder and community engagement promotes collaboration and gives service users an opportunity to actively participate in the care they receive. Recognizing this potential, The Network for Improving Quality of Care for maternal, newborn and child health aimed to identify tools and operational guidance to integrate stakeholder and community engagement into quality improvement (QI) implementation. METHODS A mapping, consisting of a literature review and an open call through email and listservers, for implementation tools was conducted. Materials were included if they provided guidance on stakeholder and community engagement aligned to the Network's QI framework comprising seven phases. Screening of tools was done by two reviewers. RESULTS The literature search and the call for tools returned 197 documents with 70 tools included after screening. Most included tools (70%) were published after 2010. International organizations were the most frequently cited authors of tools. Only 15 tools covered all seven phases of the QI framework; few tools covered the more 'technical' phase of the QI framework: adapting standards and refining strategies. CONCLUSION The quantity of tools and their varied characteristics including types of stakeholder and community engagement processes across the QI framework confirms that engagement cannot be captured in a 'one-size-fits-all' formula. Many tools were designed with a generic focus to allow for adaption and use in different settings and sectors. Country programmes looking to strengthen engagement approaches can take advantage of available tools through an online portal on the WHO website and adapt them to meet their specific needs and context. PUBLIC INVOLVEMENT Programme implementers provided tools and resources during data collection.
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Affiliation(s)
- Jessie Spencer
- Division of Public HealthMichigan State UniversityCollege of Human MedicineFlintMIUSA
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary ResearchEducation and Innovation in Health SystemsSchool of Nursing, Midwifery and Health SystemsUniversity College DublinDublinIreland
| | | | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
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Mutero IT, Chimbari MJ. Consulting the Community on Strategies to Strengthen Social Capital for Community Disease Control. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 42:272684X211004939. [PMID: 33752543 DOI: 10.1177/0272684x211004939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Excluding communities in planning and implementing research maximizes internal risks that are otherwise visible and avoidable when there is adequate community consultation. Communities might not meaningfully use research results if majority of the researched people have minimal or no participation in information generation and dissemination. However, effective participation of researched communities in research is key to transferring knowledge to action. Using a qualitative approach, the study identified barriers to, and relevant strategies for improving health research uptake, particularly for schistosomiasis (commonly known as bilharzia) in the Ingwavuma area, uMkhanyakude District of KwaZulu-Natal. Data was collected through modified ethnography using participant observation, focus group discussions, unstructured in-depth interviews, and ethnographic conversational interviews. Results reveal that research uptake is inhibited by reduced opportunities for habitual interaction between residents, a paucity of innovative and inclusive health education activities and unsafe recreational facilities. The community's strategies on strengthening social capital for disease control include using existing social systems and power hierarchies to mobilise and organise and using the performing arts to facilitate habitual interaction and knowledge sharing. The study recommends a community consultation flow which facilitates openness about the benefits and the community's role in research, a pre-condition for community wide efforts in local disease prevention and control.
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Affiliation(s)
- Innocent T Mutero
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Moses J Chimbari
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Granlund M, Imms C, King G, Andersson AK, Augustine L, Brooks R, Danielsson H, Gothilander J, Ivarsson M, Lundqvist LO, Lygnegård F, Almqvist L. Definitions and Operationalization of Mental Health Problems, Wellbeing and Participation Constructs in Children with NDD: Distinctions and Clarifications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1656. [PMID: 33572339 PMCID: PMC7916140 DOI: 10.3390/ijerph18041656] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 01/02/2023]
Abstract
Children with impairments are known to experience more restricted participation than other children. It also appears that low levels of participation are related to a higher prevalence of mental health problems in children with neurodevelopmental disorders (NDD). The purpose of this conceptual paper is to describe and define the constructs mental health problems, mental health, and participation to ensure that future research investigating participation as a means to mental health in children and adolescents with NDD is founded on conceptual clarity. We first discuss the difference between two aspects of mental health problems, namely mental disorder and mental illness. This discussion serves to highlight three areas of conceptual difficulty and their consequences for understanding the mental health of children with NDD that we then consider in the article: (1) how to define mental health problems, (2) how to define and assess mental health problems and mental health, i.e., wellbeing as separate constructs, and (3) how to describe the relationship between participation and wellbeing. We then discuss the implications of our propositions for measurement and the use of participation interventions as a means to enhance mental health (defined as wellbeing). Conclusions: Mental disorders include both diagnoses related to impairments in the developmental period, i.e., NDD and diagnoses related to mental illness. These two types of mental disorders must be separated. Children with NDD, just like other people, may exhibit aspects of both mental health problems and wellbeing simultaneously. Measures of wellbeing defined as a continuum from flourishing to languishing for children with NDD need to be designed and evaluated. Wellbeing can lead to further participation and act to protect from mental health problems.
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Affiliation(s)
- Mats Granlund
- CHILD, School of Health and Welfare, Jönköping University, 55110 Jönköping, Sweden; (A.K.A.); (F.L.)
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
| | - Christine Imms
- Department of Paediatrics, The University of Melbourne, Melbourne 3052, Australia;
| | - Gillian King
- Bloorview Research Institute, Torornto, ON M4G 1R8, Canada;
| | - Anna Karin Andersson
- CHILD, School of Health and Welfare, Jönköping University, 55110 Jönköping, Sweden; (A.K.A.); (F.L.)
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
| | - Lilly Augustine
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
- CHILD, School of Education and Communication, Jönköping University, 55110 Jönköping, Sweden
| | - Rob Brooks
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK;
| | - Henrik Danielsson
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
- Department of Behavioural Sciences and Learning, Linköping University, 58183 Linköping, Sweden
| | - Jennifer Gothilander
- School of Health, Care and Social Welfare, Mälardalen University, 72123 Vasteras, Sweden; (J.G.); (L.A.)
| | - Magnus Ivarsson
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
- Department of Behavioural Sciences and Learning, Linköping University, 58183 Linköping, Sweden
| | - Lars-Olov Lundqvist
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 70185 Örebro, Sweden
| | - Frida Lygnegård
- CHILD, School of Health and Welfare, Jönköping University, 55110 Jönköping, Sweden; (A.K.A.); (F.L.)
- The Swedish Institute for Disability Research, 58183 Linköping, Sweden; (L.A.); (H.D.); (M.I.); (L.-O.L.)
| | - Lena Almqvist
- School of Health, Care and Social Welfare, Mälardalen University, 72123 Vasteras, Sweden; (J.G.); (L.A.)
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Desai S, Misra M, Das A, Singh RJ, Sehgal M, Gram L, Kumar N, Prost A. Community interventions with women's groups to improve women's and children's health in India: a mixed-methods systematic review of effects, enablers and barriers. BMJ Glob Health 2020; 5:e003304. [PMID: 33328199 PMCID: PMC7745316 DOI: 10.1136/bmjgh-2020-003304] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION India is home to over 6 million women's groups, including self-help groups. There has been no evidence synthesis on whether and how such groups improve women's and children's health. METHODS We did a mixed-methods systematic review of quantitative and qualitative studies on women's groups in India to examine effects on women and children's health and to identify enablers and barriers to achieving outcomes. We searched 10 databases and included studies published in English from 2000 to 2019 measuring health knowledge, behaviours or outcomes. Our study population included adult women and children under 5 years. We appraised studies using standard risk of bias assessments. We compared intervention effects by level of community participation, scope of capability strengthening (individual, group or community), type of women's group and social and behaviour change techniques employed. We synthesised quantitative and qualitative studies to identify barriers and enablers related to context, intervention design and implementation, and outcome characteristics. FINDINGS We screened 21 380 studies and included 99: 19 randomised controlled trial reports, 25 quasi-experimental study reports and 55 non-experimental studies (27 quantitative and 28 qualitative). Experimental studies provided moderate-quality evidence that health interventions with women's groups can improve perinatal practices, neonatal survival, immunisation rates and women's and children's dietary diversity, and help control vector-borne diseases. Evidence of positive effects was strongest for community mobilisation interventions that built communities' capabilities and went beyond sharing information. Key enablers were inclusion of vulnerable community members, outcomes that could be reasonably expected to change through community interventions and intensity proportionate to ambition. Barriers included limited time or focus on health, outcomes not relevant to group members and health system constraints. CONCLUSION Interventions with women's groups can improve women's and children's health in India. The most effective interventions go beyond using groups to disseminate health information and seek to build communities' capabilities. TRIAL REGISTRATION NUMBER The review was registered with PROSPERO: CRD42019130633.
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Affiliation(s)
- Sapna Desai
- Population Council India, New Delhi, Delhi, India
| | | | | | | | | | - Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Neha Kumar
- International Food Policy Research Institute, Washington, DC, USA
| | - Audrey Prost
- University College London Institute of Child Health, London, UK
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Jain M, Engelbert M, Gaarder M, Bagai A, Eyers J. PROTOCOL: Use of community participation interventions to improve child immunisation in low- and middle-income countries: A systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1119. [PMID: 37016605 PMCID: PMC8356293 DOI: 10.1002/cl2.1119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Monica Jain
- International Initiative for Impact Evaluation (3ie)New DelhiIndia
| | - Mark Engelbert
- International Initiative for Impact Evaluation (3ie)New DelhiIndia
| | - Marie Gaarder
- International Initiative for Impact Evaluation (3ie)New DelhiIndia
| | - Avantika Bagai
- International Initiative for Impact Evaluation (3ie)New DelhiIndia
| | - John Eyers
- International Initiative for Impact Evaluation (3ie)New DelhiIndia
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Marston C, Sowemimo A. Bridge-It trial-a step towards better contraception services. Lancet 2020; 396:1536-1537. [PMID: 33189163 DOI: 10.1016/s0140-6736(20)32395-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Cicely Marston
- DEPTH Research Group, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Annabel Sowemimo
- Midlands Partnership NHS Foundation Trust, Haymarket Health, Leicester Integrated Sexual and Reproductive Health, Leicester, UK
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Gilmore B, Ndejjo R, Tchetchia A, de Claro V, Mago E, Diallo AA, Lopes C, Bhattacharyya S. Community engagement for COVID-19 prevention and control: a rapid evidence synthesis. BMJ Glob Health 2020. [PMID: 33051285 DOI: 10.1136/bmjgh‐2020‐003188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Community engagement has been considered a fundamental component of past outbreaks, such as Ebola. However, there is concern over the lack of involvement of communities and 'bottom-up' approaches used within COVID-19 responses thus far. Identifying how community engagement approaches have been used in past epidemics may support more robust implementation within the COVID-19 response. METHODOLOGY A rapid evidence review was conducted to identify how community engagement is used for infectious disease prevention and control during epidemics. Three databases were searched in addition to extensive snowballing for grey literature. Previous epidemics were limited to Ebola, Zika, SARS, Middle East respiratory syndromeand H1N1 since 2000. No restrictions were applied to study design or language. RESULTS From 1112 references identified, 32 articles met our inclusion criteria, which detail 37 initiatives. Six main community engagement actors were identified: local leaders, community and faith-based organisations, community groups, health facility committees, individuals and key stakeholders. These worked on different functions: designing and planning, community entry and trust building, social and behaviour change communication, risk communication, surveillance and tracing, and logistics and administration. CONCLUSION COVID-19's global presence and social transmission pathways require social and community responses. This may be particularly important to reach marginalised populations and to support equity-informed responses. Aligning previous community engagement experience with current COVID-19 community-based strategy recommendations highlights how communities can play important and active roles in prevention and control. Countries worldwide are encouraged to assess existing community engagement structures and use community engagement approaches to support contextually specific, acceptable and appropriate COVID-19 prevention and control measures.
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Affiliation(s)
- Brynne Gilmore
- 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
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Adalbert Tchetchia
- Expanded Programme on Immunization, Ministry of Health, Yaoundé, Cameroon
| | | | - Elizabeth Mago
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Alpha A Diallo
- République de Guinée Ministère de Santé, Conakry, Guinea
| | - Claudia Lopes
- United Nations University International Institute for Global Health, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Sanghita Bhattacharyya
- Public Health Foundation of India, Haryana, India.,Community Health-Community of Practice Collectivity, United Nations Children's Fund (UNICEF) Headquarters, New York City, New York, USA
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Squires F, Martin Hilber A, Cordero JP, Boydell V, Portela A, Lewis Sabin M, Steyn P. Social accountability for reproductive, maternal, newborn, child and adolescent health: A review of reviews. PLoS One 2020; 15:e0238776. [PMID: 33035242 PMCID: PMC7546481 DOI: 10.1371/journal.pone.0238776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022] Open
Abstract
Globally, increasing efforts have been made to hold duty-bearers to account for their commitments to improve reproductive, maternal, newborn, child and adolescent health (RMNCAH) over the past two decades, including via social accountability approaches: citizen-led, collective processes for holding duty-bearers to account. There have been many individual studies and several reviews of social accountability approaches but the implications of their findings to inform future accountability efforts are not clear. We addressed this gap by conducting a review of reviews in order to summarise the current evidence on social accountability for RMNCAH, identify factors contributing to intermediary outcomes and health impacts, and identify future research and implementation priorities. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42019134340). We searched eight databases and systematic review repositories and sought expert recommendations for published and unpublished reviews, with no date or language restrictions. Six reviews were analysed using narrative synthesis: four on accountability or social accountability approaches for RMNCAH, and two specifically examining perinatal mortality audits, from which we extracted information relating to community involvement in audits. Our findings confirmed that there is extensive and growing evidence for social accountability approaches, particularly community monitoring interventions. Few documented social accountability approaches to RMNCAH achieve transformational change by going beyond information-gathering and awareness-raising, and attention to marginalised and vulnerable groups, including adolescents, has not been well documented. Drawing generalisable conclusions about results was difficult, due to inconsistent nomenclature and gaps in reporting, particularly regarding objectives, contexts, and health impacts. Promising approaches for successful social accountability initiatives include careful tailoring to the social and political context, strategic planning, and multi-sectoral/multi-stakeholder approaches. Future primary research could advance the evidence by describing interventions and their results in detail and in their contexts, focusing on factors and processes affecting acceptability, adoption, and effectiveness.
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Affiliation(s)
| | - Adriane Martin Hilber
- Novametrics, Duffield, Derbyshire, United Kingdom
- Swiss Centre for International Health, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Joanna Paula Cordero
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), World Health Organization, Geneva, Switzerland
| | - Victoria Boydell
- Global Health Centre, The Graduate Institute Geneva, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Miriam Lewis Sabin
- The Partnership for Maternal, Newborn, Child & Adolescent Health, Geneva, Switzerland
| | - Petrus Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), World Health Organization, Geneva, Switzerland
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Gilmore B, Ndejjo R, Tchetchia A, de Claro V, Mago E, Diallo AA, Lopes C, Bhattacharyya S. Community engagement for COVID-19 prevention and control: a rapid evidence synthesis. BMJ Glob Health 2020; 5:e003188. [PMID: 33051285 PMCID: PMC7554411 DOI: 10.1136/bmjgh-2020-003188] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Community engagement has been considered a fundamental component of past outbreaks, such as Ebola. However, there is concern over the lack of involvement of communities and 'bottom-up' approaches used within COVID-19 responses thus far. Identifying how community engagement approaches have been used in past epidemics may support more robust implementation within the COVID-19 response. METHODOLOGY A rapid evidence review was conducted to identify how community engagement is used for infectious disease prevention and control during epidemics. Three databases were searched in addition to extensive snowballing for grey literature. Previous epidemics were limited to Ebola, Zika, SARS, Middle East respiratory syndromeand H1N1 since 2000. No restrictions were applied to study design or language. RESULTS From 1112 references identified, 32 articles met our inclusion criteria, which detail 37 initiatives. Six main community engagement actors were identified: local leaders, community and faith-based organisations, community groups, health facility committees, individuals and key stakeholders. These worked on different functions: designing and planning, community entry and trust building, social and behaviour change communication, risk communication, surveillance and tracing, and logistics and administration. CONCLUSION COVID-19's global presence and social transmission pathways require social and community responses. This may be particularly important to reach marginalised populations and to support equity-informed responses. Aligning previous community engagement experience with current COVID-19 community-based strategy recommendations highlights how communities can play important and active roles in prevention and control. Countries worldwide are encouraged to assess existing community engagement structures and use community engagement approaches to support contextually specific, acceptable and appropriate COVID-19 prevention and control measures.
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Affiliation(s)
- Brynne Gilmore
- 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
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Adalbert Tchetchia
- Expanded Programme on Immunization, Ministry of Health, Yaoundé, Cameroon
| | | | - Elizabeth Mago
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Alpha A Diallo
- République de Guinée Ministère de Santé, Conakry, Guinea
| | - Claudia Lopes
- United Nations University International Institute for Global Health, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Sanghita Bhattacharyya
- Public Health Foundation of India, Haryana, India
- Community Health-Community of Practice Collectivity, United Nations Children's Fund (UNICEF) Headquarters, New York City, New York, USA
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Fontanet CP, Fong RM, Kaiser JL, Bwalya M, Ngoma T, Vian T, Biemba G, Scott NA. A Qualitative Exploration of Community Ownership of a Maternity Waiting Home Model in Rural Zambia. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:344-357. [PMID: 33008852 PMCID: PMC7541113 DOI: 10.9745/ghsp-d-20-00136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
Community-based maternal child health programs should foster a sense of community ownership to promote sustainability. In rural Zambia, health interventions should be accessible to target communities and clear roles should be established among stakeholders for effective governance. Context: Ownership is an important construct of sustainability for community-based health programming, though it is often not clearly defined or measured. We implemented and evaluated a community-driven maternity waiting home (MWH) model in rural Zambia. We engaged stakeholders at all levels and provided intensive mentorship to an MWH governance committee comprised of community-selected members. We then examined how different stakeholders perceive community ownership of the MWH. Methods: We conducted 42 focus group discussions with community stakeholders (pregnant women, fathers, elders, and community health volunteers) and 161 in-depth interviews with MWH stakeholders (health facility staff, district health officials, and MWH governance committee and management unit members) at multiple time-points over 24 months. We conducted a content analysis and triangulated findings to understand community ownership of the MWH and observe changes in perceptions of ownership over time. Results: Community members’ perceptions of ownership were related to their ability to use the MWH and a responsibility toward its success. Community and MWH stakeholders described increasingly more specific responsibilities over time. Governance committee and management unit members perceived their ability to represent the community as a crucial component of their role. Multiple respondent types saw collaboration between the governance committee and the health facility staff as key to allowing the MWH to meet its goal of serving the community. Conclusion: The perceptions of community ownership evolved as the intervention became more established. Use of the MWH, and clear understanding of roles and responsibilities in management of the MWH, seemed to foster feelings of community ownership. To improve the sustainability of community-based maternal and child health programs, interventions should be accessible to target communities and clear roles should be established among stakeholders.
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Affiliation(s)
- Constance P Fontanet
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Misheck Bwalya
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Thandiwe Ngoma
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Taryn Vian
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Godfrey Biemba
- National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Abstract
Surge capacity is the ability to manage the increased influx of critically ill or injured patients during a sudden onset crisis. During such an event, all ordinary resources are activated and used in a systematic, structured, and planned way to cope with the situation. There are, however, occasions where conventional healthcare means are insufficient, and additional resources must be summoned. In such an event, the activation of existing capabilities within community resources can increase regional surge capacity in a flexible manner. These additional resources together represent the concept of Flexible Surge Capacity. This study aims to investigate the possibility of establishing a Flexible Surge Capacity response system to emergencies by examining the main components of surge capacity (Staff, Stuff, Structure, System) within facilities of interest present in the Western Region of Sweden. Through a mixed-method and use of (A) questionnaires and (B) semi-structured key-informant interviews, data was collected from potential alternative care facilities to determine capacities and capabilities and barriers and limitations as well as interest to be included in a flexible surge capacity response system. Both interest and ability were found in the investigated primary healthcare centers, veterinary and dental clinics, schools, and sports and hotel facilities to participate in such a system, either by receiving resources and/or drills and exercises. Barriers limiting the potential participation in this response system consisted of a varying lack of space, beds, healthcare materials, and competencies along with a need for clear organizational structure and medical responsibility. These results indicate that the concept of flexible surge capacity is a feasible approach to emergency management. Educational initiatives, drills and exercises, layperson empowerment, organizational and legal changes and sufficient funding are needed to realize the concept.
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Simbar M, Rahmanian F, Nazarpour S, Ramezankhani A, Eskandari N, Zayeri F. Design and psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services: a sequential exploratory study. BMC Public Health 2020; 20:1063. [PMID: 32631281 PMCID: PMC7336432 DOI: 10.1186/s12889-020-08913-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/13/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Providing gender sensitive reproductive health service is recently emphasized by health organizations. This study aims to develop and assess psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services (GS-PNCS) to be used by managers of perinatal services. METHODS This study is a mixed sequential (Qualitative-Quantitative) exploratory study. In the qualitative phase, 34 participants were interviewed and the items were generated. To evaluate the validity; face, content and construct validity were assessed. The reliability was assessed by internal consistency and stability calculation. RESULTS The content validity and reliability were demonstrated by S-CVR = 0.92 and S-CVI = 0.98, Cronbach's α = 0.880 and the ICC = 0.980 to 0.947. Exploratory factor analysis showed 8 factors which explained more than 52.53% of the variance. CONCLUSION GS-PNCS is a valid and reliable questionnaire, with 49 items to assess gender sensitivity of perinatal care services and helps health care managers and planners to improve the quality of the services.
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Affiliation(s)
- Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rahmanian
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Nazarpour
- Department of Midwifery, Chalous Branch, Islamic Azad University, 17 Shahrivar Street, opposite the mosque of Imam Hussain (AS), Chalous, 4661961367, Iran.
| | - Ali Ramezankhani
- Department of Public Health, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Eskandari
- Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Farid Zayeri
- Department of Biostatistics, Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Marston C, Renedo A, Miles S. Community participation is crucial in a pandemic. Lancet 2020; 395:1676-1678. [PMID: 32380042 PMCID: PMC7198202 DOI: 10.1016/s0140-6736(20)31054-0] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Cicely Marston
- DEPTH Research Group, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Alicia Renedo
- DEPTH Research Group, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Sam Miles
- DEPTH Research Group, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Carlisle K, Felton-Busch C, Cadet-James Y, Taylor J, Bailie R, Farmer J, Passey M, Matthews V, Callander E, Evans R, Kelly J, Preston R, Redman-MacLaren M, Fox H, Esterman A, Zwarenstein M, Larkins S. WOmen's Action for Mums and Bubs (WOMB) Trial Protocol: A Non-randomized Stepped Wedge Implementation Trial of Participatory Women's Groups to Improve the Health of Aboriginal and Torres Strait Islander Mothers and Children in Australia. Front Public Health 2020; 8:73. [PMID: 32257990 PMCID: PMC7093577 DOI: 10.3389/fpubh.2020.00073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/25/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: In Australia, there have been improvements in Aboriginal and Torres Strait Islander maternal health, however inequities remain. There is increasing international evidence illustrating the effectiveness of Participatory Women's Groups (PWGs) in improving Maternal and Child Health (MCH) outcomes. Using a non-randomized, cluster stepped-wedge implementation of a complex intervention with mixed methods evaluation, this study aims to test the effectiveness of PWGs in improving MCH within Indigenous primary care settings in Australia and how they operate in various contexts. Methods: This study takes place in ten primary health care services across Australia and involves the recruitment of existing PWGs or the setting up of new PWGs. Services are paired based on geography for practical reasons and two services commence the PWG intervention at three monthly intervals, with the initial four services being those with existing women's groups. Implementation of the PWGs as an intervention involves training local facilitators of PWG groups, supported engagement with local MCH data through workshops, PWGs identifying and prioritizing issues and strengths and co-implementing solutions with health services. Outcomes are measured with yearly MCH audits, a cost-effectiveness study, and process evaluation of community participation and empowerment. Discussion: This study is the first to formally implement and quantitatively, yet with contextual awareness, measure the effect of applying a community participation intervention to improve the quality of Aboriginal and Torres Strait Islander MCH in Australia. Findings from this work, including detailed theory-producing qualitative analysis, will produce new knowledge of how to facilitate improved quality of MCH care in Indigenous PHC settings and how to best engage community in driving health care improvements. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000945224. Web address: http://www.ANZCTR.org.au/ACTRN12618000945224.aspx.
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Affiliation(s)
- Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Catrina Felton-Busch
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Yvonne Cadet-James
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,Indigenous Education and Research Centre, James Cook University, Douglas, QLD, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Ross Bailie
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Jane Farmer
- Social Innovation Research Unit, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Emily Callander
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Janet Kelly
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Robyn Preston
- School of Health, Medical and Applied Science, CQUniversity, Townsville, QLD, Australia
| | - Michelle Redman-MacLaren
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,College of Medicine and Dentistry, James Cook University, Smithfied, QLD, Australia
| | - Haylee Fox
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Adrian Esterman
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD, Australia
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine and Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
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Boydell V, Schaaf M, George A, Brinkerhoff DW, Van Belle S, Khosla R. Building a transformative agenda for accountability in SRHR: lessons learned from SRHR and accountability literatures. Sex Reprod Health Matters 2020; 27:1622357. [PMID: 31533591 PMCID: PMC7942763 DOI: 10.1080/26410397.2019.1622357] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Global strategies and commitments for sexual and reproductive health and rights (SRHR) underscore the need to strengthen rights-based accountability processes. Yet there are gaps between these ambitious SRHR rights frameworks and the constrained socio-political lived realities within which these frameworks are implemented. This paper addresses these gaps by reviewing the evidence on the dynamics and concerns related to operationalising accountability in the context of SRHR. It is based on a secondary analysis of a systematic review that examined the published evidence on SRHR and accountability and also draws on the broader literature on accountability for health. Key themes include the political and ideological context, enhancing community voice and health system responsiveness, and recognising the complexity of health systems. While there is a range of accountability relationships that can be leveraged in the health system, the characteristics specific to SRHR need to be considered as they colour the capabilities and conditions in which accountability efforts occur.
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Affiliation(s)
- Victoria Boydell
- Visiting Fellow , Global Health Centre , Geneva Graduate Institute, Geneva , Switzerland
| | - Marta Schaaf
- Director of Programs and Operations, Program on Global Health Justice and Governance , Columbia University School of Public Health , New York , USA
| | - Asha George
- Chair in Health Systems, Complexity and Social Change , University of the Western Cape , Cape Town , South Africa.,Extramural Unit on Health Systems , South African Medical Research Council , Pretoria , South Africa
| | | | - Sara Van Belle
- Honorary Assistant Professor , London School of Hygiene and Tropical Medicine , London , UK.,Senior Researcher , Institute of Tropical Medicine , Antwerp, Belgium
| | - Rajat Khosla
- Human Rights Advisor , World Health Organization , Geneva , Switzerland
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50
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Tiruneh GT, Zemichael NF, Betemariam WA, Karim AM. Effectiveness of participatory community solutions strategy on improving household and provider health care behaviors and practices: A mixed-method evaluation. PLoS One 2020; 15:e0228137. [PMID: 32023275 PMCID: PMC7001957 DOI: 10.1371/journal.pone.0228137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/08/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction We implemented a participatory quality improvement strategy in eight primary health care units of Ethiopia to improve use and quality of maternal and newborn health services. Methods We evaluated the effects of this strategy using mixed-methods research. We used before-and-after (March 2016 and November 2017) cross-sectional surveys of women who had children 0–11 months to compare changes in maternal and newborn health care indicators in the 39 communities that received the intervention and the 148 communities that did not. We used propensity scores to match the intervention with the comparison communities at baseline and difference-in-difference analyses to estimate intervention effects. The qualitative method included 51 in-depth interviews of community volunteers, health extension workers, health center directors and staff, and project specialists. Results The difference-in-difference analyses indicated that 7.9 percentage points (95% confidence interval [CI]: 1.8–13.9%) increase in receiving skilled delivery care between baseline and follow-up surveys in the intervention area that is attributable to the strategy. The intervention effect on postnatal care in 48 hours of the mother was 15.3% (95% CI: 7.4–23.2). However, there was no evidence that the strategy affected the seven other maternal and newborn health care indicators considered. Interview participants said that the participatory design and implementation strategy helped them to realize gaps, identify real problems, and design appropriate solutions, and created a sense of ownership and shared responsibility for implementing interventions. Conclusions Community participation in planning and monitoring maternal and newborn health service delivery improves use of some high-impact maternal and newborn health services. The study supports the notion that participatory community strategies should be considered to foster community-responsive health systems.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- The Last Ten Kilometers (L10K) 2020 Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
- * E-mail: (GTT); (AMK)
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers (L10K) 2020 Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Wuleta Aklilu Betemariam
- The Last Ten Kilometers (L10K) 2020 Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Ali Mehryar Karim
- Bill & Melinda Gates Foundation, Addis Ababa, Ethiopia
- * E-mail: (GTT); (AMK)
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