Examining the links between community participation and health outcomes: a review of the literature

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.

An exploration of the longer-term impacts of community participation in rural health services design

“…Those that regularly, formally, participate in rural civic life, tend to have high social, cultural and economic capital , but their influence can exclude others, reinforcing socio-economic division (Shubin, 2010). Rifkin (2014) conceptualises community participation as a social process leading to public health improvements through engaging people in a learning and capacity-building exchange. She cites health commentators that regard community participation as an intervention with outcomes, for example disease control.…”

“…Researchers argue that community participation effects are difficult to robustly and consistently measure (Rifkin, 2014). Attree et al (2011) gathered evidence about individual health outcomes from types of community participation, and found evidence of health improvements, therapeutic value, gains in self-confidence and self-esteem.…”

Health Fair: Community Involvement and Ownership in Event Planning

“…It has also been enshrined as an important standard within rights based approaches to health that has a basic value in and of itself [3]. Since these landmark agreements reinforce community involvement, considerable experience has been built regarding it, with plenty of argue and reflection about its definition, rationale and outcomes [4]- [12]. Community involvement can be instrumental as working with communities can help make interventions more relevant to local needs, informed by local knowledge and priorities, and therefore more effective.…”

“…It is through empowerment that communities gain mastery over their lives and change their social and political environment to improve their health and quality of life (Wallerstein [22]). Since multiple reviews have argued the value of community participation [4]- [12], evaluations have largely focused on health outcomes. None assess the extent to which community participation figures in research on health systems interventions.…”

“…None assess the extent to which community participation figures in research on health systems interventions. It is not the intention of the review to provide a comprehensive catalogue of the literature on community participation, as this has already been done by others [4], [5], [10], [20], [23], [24]. Hence, the purpose of this research is to experience how people's congregation accelerates community ownership and demonstrates role of the stakeholders in mobilizing resources for promoting model community health practice through Health Fairs, also to see the level and scope of community involvement in event planning for health awareness intervention.…”