The architecture and effect of participation: a systematic review of community participation for communicable disease control and elimination. Implications for malaria elimination. Malar J 10:225

Pacific Malaria Initiative Support Centre, Australian Centre for International and Tropical Health, School of Population Health, University of Queensland, Brisbane, Australia.
Malaria Journal (Impact Factor: 3.11). 08/2011; 10(1):225. DOI: 10.1186/1475-2875-10-225
Source: PubMed


Community engagement and participation has played a critical role in successful disease control and elimination campaigns in many countries. Despite this, its benefits for malaria control and elimination are yet to be fully realized. This may be due to a limited understanding of the influences on participation in developing countries as well as inadequate investment in infrastructure and resources to support sustainable community participation. This paper reports the findings of an atypical systematic review of 60 years of literature in order to arrive at a more comprehensive awareness of the constructs of participation for communicable disease control and elimination and provide guidance for the current malaria elimination campaign.
Evidence derived from quantitative research was considered both independently and collectively with qualitative research papers and case reports. All papers included in the review were systematically coded using a pre-determined qualitative coding matrix that identified influences on community participation at the individual, household, community and government/civil society levels. Colour coding was also carried out to reflect the key primary health care period in which community participation programmes originated. These processes allowed exhaustive content analysis and synthesis of data in an attempt to realize conceptual development beyond that able to be achieved by individual empirical studies or case reports.
Of the 60 papers meeting the selection criteria, only four studies attempted to determine the effect of community participation on disease transmission. Due to inherent differences in their design, interventions and outcome measures, results could not be compared. However, these studies showed statistically significant reductions in disease incidence or prevalence using various forms of community participation. The use of locally selected volunteers provided with adequate training, supervision and resources are common and important elements of the success of the interventions in these studies. In addition, qualitative synthesis of all 60 papers elucidates the complex architecture of community participation for communicable disease control and elimination which is presented herein.
The current global malaria elimination campaign calls for a health systems strengthening approach to provide an enabling environment for programmes in developing countries. In order to realize the benefits of this approach it is vital to provide adequate investment in the 'people' component of health systems and understand the multi-level factors that influence their participation. The challenges of strengthening this component of health systems are discussed, as is the importance of ensuring that current global malaria elimination efforts do not derail renewed momentum towards the comprehensive primary health care approach. It is recommended that the application of the results of this systematic review be considered for other diseases of poverty in order to harmonize efforts at building 'competent communities' for communicable disease control and optimising health system effectiveness.

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    • "CHWs can improve health seeking behaviour and provide low-cost maternal and child health interventions ; cost of CHW subsystem is estimated to be $2.62 per capita, and a programme cost of $3584 per CHW Naimoli et al. (2012) Reviews broad set of interventions; role of health systems and the community CHWs can successfully deliver a range of preventive and curative services to improve health outcomes; -Number of factors influence CHW performance, including CHW, community characteristics ; service mix, contextual factors and community are involved in CHW support activities Perry and Zulliger (2012) Review of literature, expert opinion; CHWs highly effective in promoting breastfeeding; treating childhood pneumonia, diarrhoea and malaria ; reducing maternal and child mortality Abad-French et al. 2011 Systematic review of community participation in the control of Chagas disease Participation enhances control of disease but further evidence is necessary Prost et al. 2013 Systematic review of role of women's participatory groups in improving birth outcomes Women's groups are cost-effective and improve birth outcomes rapidly on a large scale Atkinson et al. 2011 Systematic review of the role of community in communicable disease control with malaria as a case study Challenges of lack of definition for 'community' and 'participation' and poor understanding of the constructs of participation and a ''peoples' component'' in control programmes Preston et al. 2010 Systematic review of evidence of community participation and improvements in rural health outcomes Lack of evidence of direct link but this did not mean lack of effect; need to improve understanding of participation in terms of time and financing and need tools to measure and understand participation Marston et al. 2013 Systematic review of evidence of effects of community participation on improving skilled care for maternal and newborn health Found very few high quality studies and none that answered question of why interventions succeed or fail; need qualitative component to study 'complex interventions' as part of RTCs Mubyazi and Hutton 2012 Review of community participation in health planning , resource allocation and service delivery from published and grey literature Barrier to evidence is lack of standard definition of 'community' and 'participation'; contribution of participation depends on many factors including system factors and socio-cultural factors; lack of data to make generalizations McCoy et al. 2011 Systematic review of health service committees Barriers to evidence is lack of standard definition of 'community' and 'participation'; lack of data for robust analysis; cannot confirm external validity; outcomes depend on process and context Molyneux et al. 2012 Review of literature on community accountability at peripheral health facilities Accountability depended on political interests, response to funding, selection, support from local and national government and relationships in committees and with other groups, health providers and managers Evans et al. 2010 Systematic review of impact of participatory approaches on UK public health units on health and social outcomes Little evidence of a direct link between participatory approaches and a 'noteworthy' impact on health and social outcomes Milton et al. 2011 Systematic review of community engagement on health and social outcomes No evidence on population health or quality of services but some positive impact on housing, crime, social capital and community empowerment "
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    ABSTRACT: As a key principle of Primary Health Care (PHC) and Health Systems Reform, community participation has a prominent place in the current global dialogue. Participation is not only promoted in the context of provision and utilization of health services. Advocates also highlight participation as a key factor in the wider context of the importance of social determinants of health and health as a human right. However, the evidence that directly links community participation to improved health status is not strong. Its absence continues to be a barrier for governments, funding agencies and health professionals to promote community participation. The purpose of this article is to review research seeking to link community participation with improved health status outcomes programmes. It updates a review undertaken by the author in 2009. The search includes published articles in the English language and examines the evidence of in the context of health care delivery including services and promotion where health professionals have defined the community’s role. The results show that in most studies community participation is defined as the intervention seeking to identify a direct causal link between participation and improved health status modeled on Randomized Control studies (RCT). The majority of studies show it is not possible to examine the link because there is no standard definition of ‘community’ and ‘participation’. Where links are found, they are situation-specific and are unpredictable and not generalizable. In the discussion, an alternative research framework is proposed arguing that community participation is better understood as a process. Once concrete interventions are identified (i.e. improved birth outcomes) then the processes producing improved health status outcomes can be examined. These processes may include and can lead to community uptake, ownership and sustainability for health improvements. However, more research is needed to ensure their validity.
    Health Policy and Planning 10/2014; 2(Supple)::ii98–ii106. DOI:10.1093/heapol/czu076 · 3.47 Impact Factor
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    • "Community-based health promotions refer to the communities’ participation in actions and activities that improve the health of, and reduce risks to, those communities. Community members might, for example, be encouraged to participate in more physical activities to improve their wellbeing [30,31] or to participate in notification and control of infections [32,33]. More information is needed to support the efficacy of current approaches in increasing community participation [30]. "
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    ABSTRACT: Background Although consumer and community engagement (CCE) in health care is receiving increasing attention, research and practice in this area are hampered by the variability of concepts and terminology commonly employed. This scoping meta-review aims to identify key CCE concepts and examine terminology used to describe them. Methods In a scoping meta-review, an extensive list of 47 phrases and 11 Medical Subject Headings (MeSH) was used to undertake a comprehensive and systematic search in PubMed Central, Embase, EBM reviews, CINAHL, APAPsycNET, and Scopus. Results 59 systematic reviews met the selection criteria and were included in the final analysis. The analysis identified nine different concepts related to CCE: shared decision making, self-management, CCE in health care systems, community-based health promotion, providing access to health care, rehabilitation, participation in research, collaboration in research design and conduct, and peer support. The identified concepts differ from each other in many aspects including the aim of the activity, the role of consumers and the type of professionals’ involvement. Each concept was described by a range of terms, with some terms shared by different concepts. In addition, two overlapping concepts of patient-centeredness and patient empowerment were recognised. Conclusions This study describes CCE-related key concepts and provides new insight into their relationship with different CCE-related terms. Identification of key CCE-related concepts and terms will be useful to focus future studies and initiatives and enhance production of CCE-related evidence.
    BMC Health Services Research 06/2014; 14(1):250. DOI:10.1186/1472-6963-14-250 · 1.71 Impact Factor
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    • "Communities affected by malaria must be supported as active participants in elimination, identifying priorities and influencing local programming approaches. It is well recognized that community involvement and ownership can be important drivers of programme success [23,47,48]. High community involvement was identified as an essential factor enabling malaria to be elimination from the island of Aneityum, Vanuatu [23]. "
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    ABSTRACT: Malaria elimination is back on the agenda, but it remains challenging for countries to make the transition from effective control to elimination. Many other infectious diseases have been targeted by globally-coordinated elimination advocacy campaigns, and advocacy has been considered an essential component of the success of other disease elimination programmes. What can the malaria community learn from these successes? A review of infectious disease elimination programmes to identify successful elements of advocacy for disease elimination was undertaken. Key elements are: (i) a global elimination plan, supported by international health bodies; (ii) thorough costings and tools to support the business case; (iii) an approach that is positioned within a development framework; (iv) core elimination advocacy messages; (v) provision of advocacy tools for partners (vi) extensive and effective community engagement; and (vii) strong partnerships. These features provide insights into 'what works' in global elimination advocacy. Advocacy is a powerful tool to support the long-term political and financial commitment necessary for malaria elimination. The global malaria community needs to work together, to ensure that the early steps towards the end goal of malaria elimination are taken.
    Malaria Journal 06/2014; 13(1):221. DOI:10.1186/1475-2875-13-221 · 3.11 Impact Factor
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