“As we have gathered with a common problem, so we seek a solution”: exploring the dynamics of a community dialogue process to encourage community participation in family planning/contraceptive programmes

Abstract

Background Community dialogues have been widely used as a method for community engagement and participation to cover a broad range of areas. However, there has been limited documentation and evaluation of the process, particularly as a method towards achieving family planning and contraception (FP/C) programme goals. As part of the development of an intervention package aimed at increasing community and health care provider (HCP) participation in the provision of FP/C, feasibility testing of the intervention approach (a community dialogue between communities and health facilities) was carried out. Our findings offer a systematic description and evaluation of the community dialogue process, with key recommendations towards future implementation. Methods The dialogue was evaluated in three ways: 1) through participant observation during the community dialogue, 2) via a standardised feasibility testing tick-list for all observers of the dialogue, and 3) through three focus group discussions (FGDs) consisting of different groups of stakeholders who participated in the community dialogue. In total, 28 community members, HCPs, and key stakeholders attended the community dialogue (22 females, 6 males). Twenty-seven of the community dialogue participants participated in one of 3 FGDs held after the dialogue. Six evaluators assessed feasibility of the dialogue process. Results There was good attendance, representation and participation amongst community and provider sectors based on the participant observations using the standardized feasibility check-list. The community dialogue process received positive feedback in the FGDs and was demonstrated to be feasible and acceptable. Key factors contributing to the success of the community dialogue included a skilled facilitator, good representation of participants, establishing ground rules, good timekeeping, and using a Theory of Change to facilitate goal identification and dialogue. Issues to consider are the underlying power differentials related to age, profession and gender which caused initial feelings of anxiety amongst some participants. Conclusions Our formative findings offer a systematic description and evaluation of a community dialogue process with key recommendations that may be considered when constituting similar community dialogues in the future.

Feasibility testing of a community dialogue approach for promoting the uptake of family planning and contraceptive services in Zambia

“…Divergence in the categories of people invited enriched the meeting as it facilitated increased representation from the community and from the health sector too, similar to what was found in South Africa [9]. The dialogue approach facilitated the engagement of the community and health care providers as it was viewed as feasible, despite cultural in uences that shape family planning and contraception outcomes.…”

“…The observations and discussions evaluated the operational and cultural feasibility of the dialogue, with focus on the following areas: perceived acceptability, demand or estimated use of the Approach, implementation or the extent or likelihood and manner in which it could be implemented as planned or proposed, practicality for deliverability based on resources, time, commitment, etc., adaptation or whether it was necessary to change contents of the proposed approach and nally, integration or the level of system change needed to integrate the proposal into existing settings [9].…”

“…This is similar to Tesfaye's nding in Ethiopia [13], though this study had over 60 participants, which is over twice the number of participants invited to the feasibility testing. This points out the need to be balanced in the total number of participants invited to the dialogue and to be mindful of the time taken for the overall dialogue [9].…”

“…Dialogues encourage the realization of perspectives and conditions of the other person or party, to identify and prioritize the needs of the community [5][6][7][8]. The dialogues aim to bring together parties that would not normally collaborate and assists them in aligning their thoughts on a particular issue [9]. A community dialogue forum allows the existing knowledge-base of each party to increase with consideration of the perspectives and views of others, and issues can be discussed and debated on in a neutral environment that allows a fair exchange of ideas [10].…”

Rationale and design of a complex intervention measuring the impact and processes of social accountability applied to contraceptive programming: CaPSAI Project

“…The study is implementing community and health provider driven social accountability interventions where service users and providers in each study country assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. The CaPSAI intervention builds on community scorecard (CSC), citizen voice and action and citizen hearing methodologies that have been implemented and evaluated by other organizations 13,35,36 . Eight common steps were distilled (Table 2) and the essential principles of these steps were identified for adaptation to local contexts, emphasizing conceptual fidelity over standardization 37,38 .…”