Abstract
BackgroundGovernment policy increasingly supports engaging communities to promote health. It is critical to consider whether such strategies are effective, for whom, and under what circumstances. However, ‘community engagement’ is defined in diverse ways and employed for different reasons. Considering the theory and context we developed a conceptual framework which informs understanding about what makes an effective (or ineffective) community engagement intervention.MethodsWe conducted a systematic review of community engagement in public health interventions using: stakeholder involvement; searching, screening, appraisal and coding of research literature; and iterative thematic syntheses and meta-analysis. A conceptual framework of community engagement was refined, following interactions between the framework and each review stage.ResultsFrom 335 included reports, three products emerged: (1) two strong theoretical ‘meta-narratives’: one, concerning the theory and practice of empowerment/engagement as an independent objective; and a more utilitarian perspective optimally configuring health services to achieve defined outcomes. These informed (2) models that were operationalized in subsequent meta-analysis. Both refined (3) the final conceptual framework. This identified multiple dimensions by which community engagement interventions may differ. Diverse combinations of intervention purpose, theory and implementation were noted, including: ways of defining communities and health needs; initial motivations for community engagement; types of participation; conditions and actions necessary for engagement; and potential issues influencing impact. Some dimensions consistently co-occurred, leading to three overarching models of effective engagement which either: utilised peer-led delivery; employed varying degrees of collaboration between communities and health services; or built on empowerment philosophies.ConclusionsOur conceptual framework and models are useful tools for considering appropriate and effective approaches to community engagement. These should be tested and adapted to facilitate intervention design and evaluation. Using this framework may disentangle the relative effectiveness of different models of community engagement, promoting effective, sustainable and appropriate initiatives.
Highlights
Government policy increasingly supports engaging communities to promote health
We report on the research synthesis which examined the theoretical and empirical literature to identify the key characteristics of community engagement interventions, organising them into a new conceptual framework which encapsulates the wide range of understandings and perspectives around community engagement, and how these are implemented in practice
Included studies and papers We purposively selected a total of 39 systematic reviews, exemplar process evaluations and theoretical papers that focused on community engagement and provided rich and unique information to develop the conceptual framework
Summary
Government policy increasingly supports engaging communities to promote health. It is critical to consider whether such strategies are effective, for whom, and under what circumstances. In order to begin framing answers to some of these questions, we need to understand what community engagement is, where the concept came from, and how it is proposed to work This will reveal how some of the different perspectives and agendas that have coalesced around the term “community engagement”; and how different approaches to engagement are thought to impact on people’s health. As well as addressing intervention effectiveness, systematic reviews present an opportunity to take stock and examine some of the assumptions underlying research activity They can ‘recast’ the literature, by analysing how research is located within particular conceptual and ethical frameworks, and tracing the development of thought over time [3, 4]
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