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

S B Rifkin,Susan B Rifkin

doi:10.1093/heapol/czu076

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.

Highlights

The global dialogue around policies for health today places much discussion on those living in poverty
This article updates an earlier review undertaken by Rifkin (2009). It is based on a systematic search of PubMed and Google Scholar for relevant articles published between 2009 and 2012. It mainly relies upon a review of published systematic reviews in English on the topic (Table A1)
The reviews identify several common issues that challenge the investigation of a direct link between participation and improved health status

Summary

Introduction

The global dialogue around policies for health today places much discussion on those living in poverty. Despite the growing interest in the role of participation, there is little concrete evidence that links participation directly to better health outcomes (Rifkin 2009). The absence of this link continues to be a barrier to gain full support of governments, funding agencies and health professionals to promote this approach (Atkinson et al 2011). The purpose of this article is to review the research that seeks to examine the links between community participation and improve health outcomes in programmes that target poor people. To do this, it starts with systematic reviews and case studies from 2003 to 2013. It suggests that if community participation is viewed as a process facilitating an intervention rather than an intervention research investigating the link between participation and health status outcomes would have greater validity reflecting how intended beneficiaries see their situations rather than the views of policy makers and planners

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Discussion

Conclusion