Abstract
BackgroundCommunity mobilization (CM) is recommended as a best practice intervention for low resource settings to reduce maternal mortality. Measurement of process outcomes are lacking and little is known about how CM impacts individuals or how community members perceive its function. Given the complex and recursive nature of CM interventions, research that describes the CM process at multiple levels is needed. This study examines change in CM domains at baseline and endline in rural Zambia.MethodsThis secondary analysis uses data from a large maternity waiting homes intervention in rural Zambia that employed CM over 3 years as part of a package of interventions. A 19-item CM survey was collected from three groups (women with babies < 1, health workers, community members; n = 1202) with focus groups (n = 76) at two timepoints from ten intervention and ten comparison sites. Factor analysis refined factors used to assess temporal change through multivariable regression. Independent covariates included time (baseline vs endline), intervention vs comparison site, group (women with babies, healthworkers, community members), and demographic variables. Interaction effects were checked for time and group for each factor.ResultsFinal analyses included 1202 individuals from two districts in Zambia. Factor analysis maintained domains of governance, collective efficacy, self-efficacy, and power in relationships. CM domains of self-efficacy, power in relationships, and governance showed significant change over time in multivariable models. All increases in the self-efficacy factor were isolated within intervention communities (b = 0.34, p < 0.001) at endline. Between groups comparison showed the women with babies groups consistently had lower factor scores than the healthworkers or community member groups.ConclusionsCommunity mobilization interventions increase participation in communities to address health as a human right as called for in the 1978 Alma Ata Declaration. Grounded in empowerment, CM addresses socially prescribed power imbalances and health equity through a capacity building approach. These data reflect CM interventions function and have impact in different ways for different groups within the same community. Engaging directly with marginalized groups, using the community action cycle, and simultaneous quality improvement at the facility level may increase benefit for all groups, yet requires further testing in rural Zambia.
Highlights
Community mobilization (CM) is recommended as a best practice intervention for low resource set‐ tings to reduce maternal mortality
Guided by an investigator derived CM Theory of Change (Fig. 1), the aims of this study were twofold:1) Examine the factor structure of a CM survey among rural Zambians using baseline and endline data and 2) Examine the change in domains of CM among a sample of rural Zambians from three groups within 10 communities surrounding the Zambian Mother’s Shelters (ZaMS) using baseline (n = 553) and endline CM survey data (n = 649). This secondary analysis uses cross-sectional data at two time points from a parent study investigating the impact of maternity waiting homes (MWHs) to examine proposed domains of CM and their change over 3 years among rural Zambians
This study was deemed exempt and not regulated by the University of Michigan IRB (HUM00165339). The dataset for these analyses come from an evaluation of MWHs which began in May 2015 and concluded in July 2018 in partnership between researchers at the University of Michigan School of Nursing and Africare-Zambia
Summary
Community mobilization (CM) is recommended as a best practice intervention for low resource set‐ tings to reduce maternal mortality. Community mobilization (CM) is recommended by the World Health Organization as a best practice intervention for low resource settings to reduce maternal and neonatal mortality [1]. The linking constructs isolated were organized within 8 domains (collective action, collective agency, collective efficacy, collective identity, governance, perceived similarity, social acceptance/cohesion, social networks/support) said to influence CM outcomes. A validated scale evaluating CM domains pertinent to the rural South African context includes domains of shared concern, critical consciousness, leadership, organizations/networks, collective action, social cohesion, and social control [11]. Despite these available tools, CM interventions rarely incorporate process evaluation using linking constructs representing CM domains
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