A realist review of community engagement with health research

Abstract

Introduction: Community engagement is increasingly recognized as a critical aspect of global health. Recent years have seen an expansion of community engagement activities linked to health research, but debates and inconsistencies remain about the aims of different types of engagement, mechanisms underpinning their implementation and impact, and influential contextual factors. Greater commitment to and consistency around community engagement by health research programs, implementers and funders requires a more coherent evidence base. This realist review is designed to improve our understanding of how and why community engagement contributes to intended and unintended outcomes (including research and ethical outcomes) in different contexts. Given the breadth and diversity of the literature on community engagement in health research, the review will initially focus on malaria research in low- and middle-income countries (LMICs) and draw on wider global health literature where needed. Methods and analysis: Community engagement in practice is often a complex set of interventions. We will conduct a realist review – a theory driven approach to evidence synthesis – to provide explanations for how and why community engagement with health research produces the pattern of outcomes observed across different contexts of application. We will consolidate evidence from a range of documents, including qualitative, quantitative and mixed method studies. The review will follow several stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesizing and refining the programme theory, and reiteration of these steps as needed. Ethics and dissemination: A formal ethics review is not required for this literature review. Findings will be disseminated in a peer reviewed journal, through national and international conferences, and through a set of short briefings tailored for audiences with an interest in community engagement. Outputs and presentations will be informed by and feed into our network of community engagement experts. PROSPERO registration number: CRD42019125687

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements

“…15 17 Insights from micro-level and meso-level are important for informing change at the macro-level where policies are formulated and decided 16 ; and for generating community awareness and ownership of solutions for improving healthcare access. 17…”

Factors influencing decisions about whether to participate in health research by people of diverse ethnic and cultural backgrounds: a realist review

“…A systematic review found that it is a concept that is rarely explicitly named in abstracts and titles and rarely engaged with; lack of acknowledgement of its existence could be holding back discovery within this field. [63][64][65][66][67][68][69][70][71][72][73][74] Programme theory A resultant programme theory was produced following the five steps shown in figure 4. The programme theory informed discussions with stakeholders to develop recommendations and actions (table 1) for individuals, organisations, institutions and policymakers to improve the informed consent process.…”

A realist review protocol on communications for community engagement in maternal and newborn health programmes in low- and middle-income countries

“…The broader outcomes of CE vary with the goals or purpose of the intervention in which it is incorporated [ 24 ]. CE has been used to enable community participation, protect communities’ interests, tailor programmes to a community’s needs, build capacity, and encourage programme acceptance [ 25 – 27 ].…”

“…The recent civil wars and the challenging process of rebuilding trustworthy structures of governance could explain, in part, the community resistance and mistrust that was common throughout the epidemic; this was also reflected in the approaches of CE during the response [ 13 , 32 , 39 – 41 ]. Existing relationships and social hierarchies, socioeconomic status, cultural beliefs and values, the state of the health system, and community perceptions and knowledge are all contextual factors to be considered in the development and implementation of CE strategies [ 13 , 22 , 24 , 32 , 35 , 37 , 42 , 43 ].…”

“…This can be applied to CE by investigating a programme’s generative causation — essentially which mechanisms (M) underpin effective CE interventions and the contexts (C) that trigger these mechanisms to generate the observed outcomes (O). The complexity of CE programmes as well as the importance of context in implementing CE make this subject well-suited for a realist synthesis [ 17 , 24 , 47 ]. A realist review can be used to provide a deeper understanding of what CE interventions in MNH work, for whom, to what extent, why, and how [ 48 ].…”