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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] [What about the content of this article? (0)] [Affiliation(s)] [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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