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Abstract The importance of community engagement (CE) for health system resilience is established in theoretical and empirical literature. The practical dimensions of how to operationalize theory and implement its principles have been less explored, especially within low-resource crisis settings. It is therefore unclear how CE is drawn upon and how, if at all, it facilitates health system resilience in times of health system crises. To address this critical gap, we adapt and apply existing theoretical CE frameworks to analyse qualitative data from 92 in-depth interviews and 16 focus group discussions collected with health system stakeholders in Liberia in the aftermath of the 2014–15 Ebola outbreak. Health system stakeholders indicated that CE was a crucial contributing factor in addressing the Ebola epidemic in Liberia. Multiple forms of CE were used during the outbreak; however, only some forms were perceived as meaningful, such as the formation of community-based surveillance teams. To achieve meaningful CE, participants recommended that communities be treated as active participants in—as opposed to passive recipients of—health response efforts and that communication platforms for CE be established ahead of a crisis. Participant responses highlight that meaningful CE led to improved communication with and increased trust in health authorities and programming. This facilitated health system response efforts, leading to a fortuitous cycle of increased trust, improved communication and continued meaningful CE—all necessary conditions for health system resilience. This study refines our understanding of CE and demonstrates the ways in which meaningful CE and trust work together in mutually reinforcing and beneficial ways. These findings provide empirical evidence on which to base policies and programmes aimed at improving health system resilience in low-resource settings to more effectively respond to health system crises.

Background There is increasing evidence of the negative impact of the COVID-19 pandemic and resultant shutdowns on mental health. This issue may be of particular concern to those affected by intimate partner violence (IPV) and sexual violence. Methods We conducted a cross-sectional analysis using data from a California state-representative online survey conducted in the two weeks following the state stay-at-home order, enacted March 19, 2020 (unweighted N = 2081). We conducted a series of multivariate multinomial logistic regressions to assess the associations between a) time since stay-at-home order and b) partner and sexual violence exposure ever with our outcomes of interest: depression and/or anxiety symptoms in the past two weeks. Covariates included demographics and social support. Findings Nearly one in five (19•7%) respondents reported moderate or severe mental health symptoms in the past two weeks; 15•5% had a history of IPV and 10•1% had a history of sexual violence. In models adjusting for gender, partner and sexual violence history, and other demographics, time was significantly associated with greater mental health symptom severity, as were IPV and sexual violence. When we additionally adjusted for current social support, effects of time were lost and effects related to violence were slightly attenuated. Interpretation Time under shutdown is associated with higher odds of depression and anxiety symptoms, and may be worse for those with a history of IPV. However, those with greater social support appear to have better capacity to withstand the mental health impacts of the pandemic. Social support programs, inclusive of those available virtually, may offer an important opportunity to help address increased mental health concerns we are seeing under the pandemic. Funding Blue Shield Foundation of California Grant RP-1907–137. Bill and Melinda Gates Foundation OPP1179208.

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Sexual violence in sport is prevalent and represents a serious public health concern. The social-ecological model for health promotion has been used successfully as a framework to identify individual-to-policy level factors aimed at health promotion or disease prevention. The purpose of this review was to examine both published and non-published (publicly available) SVP efforts conducted within the context of sport and make recommendations for future practice. Grey literature search methods were utilized to conduct a review of publicly available documents. This included (a) a comprehensive Google search using unique search terms that would identify SVP efforts within sport settings and (b) a review of the publicly accessible websites identified in the previous step. Following the grey literature search, and using the SVP practices identified in step one, we conducted a supplementary literature search using scientific publication search engines to identify whether the SVP practices identified in step one had associated peer-reviewed publications. Finally, we assessed various characteristics of each SVP practice including the target population, age range of intended participants, and whether the SVP had associated peer review publications. This led to the identification of 35 unique SVP practices: 25 (71%) SVP practices were assigned to the Intrapersonal level, 6 (17%) were assigned to the Interpersonal level, 9 (26%) were assigned to the Organizational level, 3 (9%) were assigned to the Community, and 2 (6%) were assigned to the Policy level. This review uncovered several important findings including a lack of multi-level SVP practices within sport, a lack of SVP practices that target children, minimal programming aimed at specifically preventing perpetration, the need to elevate policy level action, and a lack of peer-reviewed literature. Ultimately findings suggest that sport organizations ought to prioritize sexual violence prevention using national organizations for guidance.