Community-led Approach Research Articles

Harambee! 2.0: The Impact of HIV-Related and Intersectional Stigmas on HIV Testing Behaviors Among African Immigrant Communities in Seattle, Washington.

African immigrants are disproportionately affected by HIV compared to U.S.-born individuals, and early HIV testing is the key challenge in ending the HIV epidemic in these communities. HIV-related stigma appears to be the most significant barrier to testing for HIV among African communities in King County, WA. In this formative study, we conducted thirty key informant interviews and five focus group discussions (n = total 72 participants) with Ethiopian, Somali, and Eritrean people living with HIV, health professionals, religious and other community leaders, and lay community members in King County to better understand HIV-related and intersectional stigmas’ impact on HIV testing behaviors. We used inductive coding and thematic analysis. Participants from all communities reported similar themes for HIV-related and intersectional stigmas’ influences on HIV testing behaviors. Misconceptions or poor messaging, e.g., regarding treatability of HIV, as well as normative or religious/moral beliefs around pre/extramarital sex contributed to HIV-related stigma. Intersecting identities such as immigrant status, race/ethnicity, and having a non-English language preference, all intermingle to further influence access to the U.S. healthcare system, including for HIV testing. These findings can be used to inform future research on community-led approaches to addressing early HIV testing amongst African immigrant communities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10461-021-03396-5.

Taking small steps: Sensitising the police through male sex workers’ community-led advocacy in Nairobi, Kenya

ABSTRACT Kenyan sex worker-led organisations (SWLOs) often play a key role in the national HIV response. Accounts of these organisations frequently focus on their community-led approaches to promote sexual health. This paper addresses sensitisation, an underexplored but significant activity in the political agency of sex workers (SWs). Drawing on ethnographic fieldwork in a male SWLO in Nairobi, we examine how male SWs strategically use their position in the national HIV response to create spaces of police sensitisation. Taking police sensitisation as a manifestation of community-led advocacy and a ‘politics of small steps’, we examine how SWs respond to, resist and remake the political landscape of police violence. The strategy supports SWs in changing existing power relationships between themselves and the police, albeit within the confines of a criminalising legal system. The analysis of sensitisation practices supports a reimagining of SWLOs that stresses their political agency in the production of new political spaces and expands the focus on African SWLOs beyond HIV work to their political activities, which advance SWs’ health, rights and social justice.

Can rural stakeholders drive the low-carbon transition? Analysis of climate-related activities planned in local development strategies in Poland

In the postulated efforts to limit adverse climate change (CC), increasing attention is paid to the development of distributed renewable energy (RE) that meets the needs of local communities on the spot. This article analyses the objectives, planned actions and performance indicators related to CC and RE, defined by national and local stakeholders in: (1) the national Rural Development Programme (RDP) 2014–2020 in Poland and (2) in the bottom-up Local Development Strategies (LDS) financed from RDP and using a Community-Led Local Development approach. The content analysis method was used. We found that the strategy documents considered, created in the years 2014–2015, paid relatively little attention to local actions related to CC and RE. Some educational activities related to adaptation and mitigation of CC were planned in 66% of LDS, while investment support for RE was planned only in 9% of the LDS. Traditional goals such as supporting local businesses and farmers, local cultural heritage and the development of human and social capital were seen as more important. The results of the analysis suggest a relatively low level of interest from rural-policy actors in Poland in implementing the climate-friendly objectives of the Europe 2020 strategy. This article contributes to understanding why Poland failed to meet the European 2020 RE development goals. These issues are discussed in the context of national and continental climate policy and problems of transformation to post-carbon society.

Social media influencers can be used to deliver positive information about the flu vaccine: findings from a multi-year study

Large-scale digital flu vaccine campaigns have experienced difficulty increasing vaccination coverage among African Americans and Hispanics, and are routinely inundated by negative responses from vaccine opponents. A digital campaign employing user-generated content from social media ‘micro’ influencers who are predominantly followed by African Americans and Hispanics was implemented during the 2018–19 and 2019–20 flu seasons to disseminate positive information about the flu vaccine. At the time, this constituted the largest influencer-driven health campaign focused on these communities in the United States. Comments on posts were qualitatively coded to determine content perceptions among those exposed to posts. Digital metrics were also analyzed. During Year 1, posts reached 9 million+ social media users and generated 64 612 likes or shares, and 1512 responses. In Year 2, posts reached 8 million+ users and generated 155 600 likes or shares, and 3122 responses. Around 94% of public responses to posts were positive, suggesting this is a promising strategy to communicate health information and could shift social norms, particularly for heavily debated topics such as vaccination. This strategy represents a more community-led and participatory approach than most large-scale vaccination campaigns have attempted, with immediate applicability to communications about the COVID-19 vaccine.

The AIDS pandemic in the 2020s: community responses bring female underserved populations into sharper focus.

The AIDS pandemic in the 2020s: community responses bring female underserved populations into sharper focus.

Sustaining Forest Ecosystem Services Through Social Enterprises: Motivations and Challenges from a Case Study in Scotland

Both the concepts of ecosystem services and social enterprise have gained popularity as means of addressing social and environmental issues in recent years. But while research on ecosystem services has focused on non-governmental organisation and local community-led approaches, the role of social enterprises has received less attention. In Scotland, social enterprises play an important role in delivering social and environmental justice, as well as reaping economic benefits through forest-based practices. These practices are often small-scale and attract participants from local communities. But despite this prominence their motivations and the challenges they face remain largely unexplored. This research attempts to integrate both concepts mainly using field observations and interviews, and to reinforce the findings with the existing literature. It explores the motivations and challenges of social enterprises in sustaining forest ecosystem services through a case study, and discusses their potential within the context of current policy. The research suggests that social enterprises are equipped to tackle a range of social and environmental issues. The enterprise under investigation aims to improve participants’ wellbeing and employability, as well as to provide public education and promote environmental awareness. But these efforts are often hindered by the difficulties of high requirements of the manager and staff members in balancing multiple objectives and most importantly, of managing financial risks. The research concludes that a practical method of assessing cultural ecosystem services as well as the use of innovative funding norms may resolve these challenges, allowing social enterprises to fill the current policy gap and create synergies in the fields of ecosystem services and social enterprise.

How Do Rural Communities Sustain Sanitation Gains? Qualitative Comparative Analyses of Community-Led Approaches in Cambodia and Ghana

Community-led Total Sanitation (CLTS) is a popular intervention for eliminating open defecation in rural communities. Previous research has explored the contextual and programmatic factors that influence CLTS performance. Less is known about the community-level conditions that sustain latrine coverage and use. We hypothesized three categories of community conditions underlying CLTS sustainability: (i) engagement of community leaders, (ii) follow-up intensity, and (iii) support to poor households. We evaluated these among communities in Cambodia and Ghana, and applied fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify combinations of conditions that influenced current latrine coverage and consistent latrine use. In Cambodia, latrine coverage was highest in communities with active commune-level leaders rather than traditional leaders, and with leaders who used casual approaches for promoting latrine construction. Latrine use in Cambodia was less consistent among communities with intense commune engagement, higher pressure from traditional leaders, high follow-up and high financial support. In Ghana, by contrast, active leaders, high follow-up, high pro-poor support, and continued activities post-implementation promoted latrine coverage and consistent use. The different responses to CLTS programming emphasize that rural communities do not have homogenous reactions to CLTS. Accounting for community perceptions and context when designing community-led interventions can foster long-term sustainability beyond short-term achievement.

Family poultry development systems among smallholder broiler farmers in the Goromonzi district of Zimbabwe

ABSTRACT This paper analyzes the dynamics at play in community poultry projects in Zimbabwe. We compare the performance levels of “family poultry” under three community-based development schemes: the contract-based scheme and the two community-led poultry development approaches, one supported by an NGO and the other under self-funding. Factors that influence farmers’ choice of the poultry scheme are also determined. Data was collected using observations and self-administered questionnaires from 61 smallholder poultry farmers in the Goromonzi District. Results indicate that landholding and distance to the nearest urban center influence the farmers’ choice of poultry scheme and that no single scheme is superior to the other. While the contract-based scheme records the highest sales and bird per cycle, it undermines the community’s capabilities to act independently. Contractors control price, marketing, and genetic-type decisions. In contrast, the other approaches have lower material returns, but they build the community’s broad-based capabilities for self-improvement.

An Area-Specific, International Community-Led Approach to Understanding and Addressing Equality, Diversity, and Inclusion Issues within Supramolecular Chemistry.

Diversity, equality, and inclusion (DEI/EDI) are pressing issues in chemistry and the natural sciences. In this Essay we share how an area‐specific approach is “calling in” the community so that it can act to address EDI issues, and support those who are marginalised. Women In Supramolecular Chemistry (WISC) is an international network that aims to support equality, diversity, and inclusion within supramolecular chemistry. WISC has taken a field‐specific approach using qualitative research methods with scientists to identify the support that is needed and the problems the supramolecular community needs to address. Herein, we present survey data from the community which highlight the barriers that are faced by those who take career breaks for any reason, a common example is maternity leave, and the importance of mentoring to aid progression post‐PhD. In conclusion, we set out an interdisciplinary and creative approach to addressing EDI issues within supramolecular chemistry.

Changes over time in HIV testing and counselling uptake and associated factors among youth in Zambia: a cross-sectional analysis of demographic and health surveys from 2007 to 2018

IntroductionZambia is among the countries with the highest HIV burden and where youth remain disproportionally affected. Access to HIV testing and counselling (HTC) is a crucial step to ensure the reduction of HIV transmission. This study examines the changes that occurred between 2007 and 2018 in access to HTC, inequities in testing uptake, and determinants of HTC uptake among youth.MethodsWe carried out repeated cross-sectional analyses using three Zambian Demographic and Health Surveys (2007, 2013–14, and 2018). We calculated the percentage of women and men ages 15–24 years old who were tested for HIV in the last 12 months. We analysed inequity in HTC coverage using indicators of absolute inequality. We performed bivariate and multivariate logistic regression analyses to identify predictors of HTC uptake in the last 12 months.ResultsHIV testing uptake increased between 2007 and 2018, from 45 to 92% among pregnant women, 10 to 58% among non-pregnant women, and from 10 to 49% among men. By 2018 roughly 60% of youth tested in the past 12 months used a government health centre. Mobile clinics were the second most common source reaching up to 32% among adolescent boys by 2018. Multivariate analysis conducted among men and non-pregnant women showed higher odds of testing among 20–24 year-olds than adolescents (aOR = 1.55 [95%CI:1.30–1.84], among men; and aOR = 1.74 [1.40–2.15] among women). Among men, being circumcised (aOR = 1.57 [1.32–1.88]) and in a union (aOR = 2.44 [1.83–3.25]) were associated with increased odds of testing. For women greater odds of testing were associated with higher levels of education (aOR = 6.97 [2.82–17.19]). Education-based inequity was considerably widened among women than men by 2018.ConclusionHTC uptake among Zambian youth improved considerably by 2018 and reached 65 and 49% tested in the last 12 months for women and men, respectively. However, achieving the goal of 95% envisioned by 2020 will require sustaining the success gained through government health centres, and scaling up the community-led approaches that have proven acceptable and effective in reaching young men and adolescent girls who are less easy to reach through the government facilities.

Community led post-earthquake heritage reconstruction in Patan–issues and lessons learned

Earthquake of 7.8 magnitude hit Nepal on April 25, 2015 leading to severe damage to its heritage buildings. Cultural heritage is an expression of the ways of living, developed by a community and passed on from generation to generation including customs, practices, places, tangible objects, artistic expressions, and values. In addition to the reconstruction of monuments within Patan Durbar Area, Kathmandu Valley Preservation Trust (KVPT) is working with communities of Patan and providing technical support to the reconstruction of their community buildings such as Phalcha / Pati, Chaapa:,Sattal, Guthighar and Aganchhen. Communities in collaboration with local government and lead agencies for heritage conservation are addressing heritage reconstruction. Community-led reconstruction is recognised by both Government of Nepal (GoN) and public as an important approach. The purpose of this paper is to examine community-led reconstruction approach undertaken by communities of Patan and share issues, success stories and lessons learnt where KVPT provided technical support. A literature review of documents related to the reconstruction and heritage buildings were conducted. Following a case study method and using qualitative method, data is captured from community members and technical personnel involved in reconstruction. A comparative chart with case studies is created to depict the issues hindering community-led heritage reconstruction. From this study it is found that people of Patan have sense of belonging to their heritage. They are interested in taking part and leading the reconstruction process. However, challenges exist in terms of budget, awareness on traditional methods and construction management, technical, social process and bureaucratic procedures. For successful project completion, there is a need of knowledge sharing and capacity building of communities who want to lead heritage reconstruction. The result from this paper can be used by communities as key points to frame their own reconstruction plans and by GoN to devise strategies to support communities who want to lead heritage reconstruction.

Community intervention strategies to reduce the impact of financial strain and promote financial well-being: a comprehensive rapid review.

Financial well-being describes when people feel able to meet their financial obligations, feel financially secure and are able to make choices that benefit their quality of life. Financial strain occurs when people are unable to pay their bills, feel stressed about money and experience negative impacts on their quality of life and health. In the face of the global economic repercussions of the COVID-19 pandemic, community-led approaches are required to address the setting-specific needs of residents and reduce the adverse impacts of widespread financial strain. To encourage evidence-informed best practices, a provincial health authority and community-engaged research centre collaborated to conduct a rapid review. We augmented the rapid review with an environmental scan and interviews. Our data focused on Western Canada and was collected prior to the pandemic (May–September 2019). We identified eight categories of community-led strategies to promote financial well-being: systems navigation and access; financial literacy and skills; emergency financial assistance; asset building; events and attractions; employment and educational support; transportation; and housing. We noted significant gaps in the evidence, including methodological limitations of the included studies (e.g. generalisability, small sample size), a lack of reporting on the mechanisms leading to the outcomes and evaluation of long-term impacts, sparse practice-based data on evaluation methods and outcomes, and limited intervention details in the published literature. Critically, few of the included interventions specifically targeted financial strain and/or well-being. We discuss the implications of these gaps in addition to possibilities and priorities for future research and practice. We also consider the results in relation to the COVID-19 pandemic and its economic consequences.

Impact of community-led local development on territorial prosperity

Community-led local development is an approach that is increasingly applied in traditional territorial development policy. In this method, management is left in the “hands of local people”, who receive long-term funding, which they distribute according to the needs of the region. The aim of the study is to examine the impact and participation in the development of the territory through CLLD measures. The expert assessment and recommendations of the surveyed LAG leaders and specialists regarding the contribution of the community-led local development approach have been sought. The applied research methods in the present study are theoretical and empirical, incl. analysis, synthesis, comparison, survey, statistical processing. The results of the survey show that the majority of respondents are satisfied with the implementation of CLLD and have clear and concrete proposals for improving the approach in the next programming period. In conclusion it is necessary to note that despite all difficulties, the interest in CLLD on the part of local communities is very high, because the approach provides many opportunities to solve problems related to local development. Key words: community-led local development, LEADER program, LAG, territorial prosperity.

Community Initiated Adaptive Reuse for Culture and the Arts: ‘The Tanks Arts Centre’ Cairns, Australia

A group of World War II naval fuel storage tanks strategically located in a tropical rainforest in Cairns, Australia, were adapted for arts and cultural purposes. This paper explores the adaptive reuse of this unusual industrial heritage site. It uses a case study approach to demonstrate how the social and aesthetic values of the place have been conserved and grown, and how these values have interacted to increase community attachment through a community-initiated approach to the site’s reuse. A scoping review and secondary data helped develop the case study and informed semi-structured interview questions for key industry stakeholders. The paper deduces that a community-led bottom-up approach to the reuse of space for arts and culture results in greater community attachment and, as opposed to top-down approaches, allows for continued growth in social and aesthetic value. Nevertheless, ongoing success of community initiatives in most cases is also reliant on the structure of a government-led administration.

Healthier Together: Co-design of a culturally tailored childhood obesity community prevention program for Māori & Pacific Islander children and families.

Children of Māori & Pacific Islander descent living in Australia have a greater prevalence of overweight/obesity and an increased risk of adverse health outcomes. This study aimed to co-design Healthier Together, a community-based, childhood overweight/obesity prevention program tailored to Māori & Pacific Islander cultures. Co-design involved a three-phase, iterative, participatory and experience-based process, guided by the Te Ara Tika: Guidelines for Māori Research Ethics to promote respect and equity. Following traditional oratory customs of Māori & Pacific Islander cultures, "talanoa" facilitated the collaborative program design with recruited Māori & Pacific Islander consumers, cultural advisors and health professionals. Co-design formulated program objectives, session plans, resources and evaluation tools. Co-design developed a 9-week community-based childhood overweight/obesity prevention program providing culturally tailored education across four themes: (a) nutrition (b) physical activity (c) positive parenting practices (d) culture and health. Strong community engagement developed a program highly tailored to the local Māori & Pacific Islander population. Co-design methodology promotes equity and inclusion of all stakeholders, acknowledges and caters to diversity and creates a medium for openness, respect and shared purpose. Community-led participatory approaches are pivotal to engaging and empowering communities to successfully improve health behaviours, particularly in tackling childhood overweight/obesity. SO WHAT?: Healthier Together is culturally significant to ensure relevance, effectiveness and sustainability. It is relevant and potentially adaptable to other priority populations across Australia and globally. Ultimately, the delivery of culturally tailored health care will contribute to a reduction in the health inequity experienced amongst priority populations.

Finding the Rainbow Needle in the Research Haystack

This article will discuss the fundamental importance of community-led, organic research methodologies when uncovering and revealing LGBTQIA+ identities within the Irish national collection. Using the National Gallery of Ireland as a case study, the paper highlights the importance of this research in an Irish context. The representation of the LGBTQIA+ community in historical and cultural institutions in Ireland has grown in the past four years. This is partly due to the Marriage Equality Referendum passing in favour of equal marriage in 2015. With this increased acceptance from the people of Ireland, more members of the community are actively reflecting on their place in society and history. To best direct this communal reflection, a cyclical research methodology was applied to uncovering previously overlooked LGBTQIA+ representation in the Gallery’s collection. Initial research into key works was disseminated via public LGBTQIA+ tours of the collection. Tour participants’ feedback and ideas were gathered over several months and guided further research. This community-led approach has yielded a new directory of some 30 works and artists that will be shared on the Gallery’s website for the general public to access. Engaging with the LGBTQIA+ community when carrying out this research has been of fundamental importance. Until recently, this community in Ireland has been largely ignored by historians, researchers, and curators. To reveal, commemorate, and celebrate queer stories and sources from these times, the voices of the existing community are essential. The foundation of the LGBTQIA+ Research Network and plans for an island-wide database will ensure that these voices will no longer be ignored.

Effect of a Pilot Programme by Capability Approach to Prevent Lifestyle-related Diseases in Kaski, Nepal

In the rural area of Nepal, lifestyle-related non-communicable diseases (NCDs) are emerging in recent days. We piloted a program model (2017-2019) to protect people from lifestyle-related diseases in a remote village of Kaski district where the health facilities are limited. This program was supported by Japan International Corporation Agency. We aimed to initiate a simple model of health monitoring to reduce the risks of lifestyle-related diseases. Health monitoring (blood pressure and body weight measurement) together with peer education regarding lifestyle-related disease was conducted by trained volunteers on regular bases. One-group pre-test–post-test research design was used to measure the impact of the program on the 104 participants with the age ranging 52±8.99 years in female and 57±7.38 years in male, sampled from the 100 households in the target village, Gairegaon. The double burden of underweight and overweight was observed in the programming community. After the program was conducted for one year, the percentage of people who is in the normal body mass index (BMI) range was significantly increased from 68.2% to 75.9% in total. Similarly, the ratio of normal blood pressure rose up significantly from 40.4% to 59.6%. This program results suggested that the community-led capability approach works effectively with locally affordable cost to change the behavior of people to reduce the risk of lifestyle-related diseases.

Using Social Media Influencers to Deliver Positive Information About the Flu Vaccine: Findings from a Multi-Year Qualitative Study

Introduction: Large-scale flu vaccine campaigns have experienced difficulty in increasing vaccination coverage among African Americans and Hispanics. Digital campaigns about flu vaccination are routinely inundated by negative responses from those in opposition to vaccines. To address this issue, from September 2018 - March 2020 and September 2019 – March 2020, a digital campaign was implemented to disseminate positive information about the flu vaccine. Methods: The campaign employed user-generated content from social media “micro” influencers who are predominantly followed by African Americans or Hispanics. Influencers wrote messages promoting the flu vaccine and posted them on their personal social media accounts. To date, this constituted the largest influencer-driven health campaign focused on reaching these communities in the United States. Analysts qualitatively coded public comments on influencer posts to determine content perceptions among those exposed to posts. Digital metrics were also analyzed. Results: In Year 1, influencer posts reached over 9 million individuals on social media and generated 64,612 likes or shares, and 1,512 responses. In Year 2, posts reached over 8 million individuals and generated 155,600 likes or shares, and 3,122 responses. On average, around 94% of public responses to posts were positive. Conclusions: This campaign strategy represents a more community-led and participatory approach than large-scale vaccination campaigns have attempted to date. The overwhelmingly positive responses to influencer posts suggest that this may be a promising strategy to communicate health information and could ultimately shift social norms, particularly for heavily debated topics such as vaccination.

Public value governance meets social commons: community anchor organisations as catalysts for public service reform and social change?

ABSTRACT Scottish public service reform is one example of an emerging international vision for state-convened public value governance. Scottish Government focus on community empowerment has legitimised discussions of community-led approaches and offers cautious policy support for community anchor organisations. In this context, community studies scholars and community sector continue to reflect critically on complex relations between state and community, with some exploring a social commons as a distinctive aspiration for democratic governance. In this paper, our participatory research with six community anchor exemplars and wider stakeholders provides empirical material to support discussion, interpretation and analysis at ‘the frontier’ of these visions of governance. We consider the potential for anchors to offer collaborative leadership to facilitate cross-sector partnership and participation and agonistic leadership to provide countervailing, constructive challenge to the state. We conclude by advancing a research agenda to explore further community sector leadership at times of increasing social and ecological crisis.

Beyond remedicalisation: a community-led PrEP demonstration project among sex workers in India

Global health policy-makers have called for demonstration projects to better understand pre-exposure prophylaxis’ (PrEP) effectiveness across geographies and populations. Ashodaya, a sex worker collective, initiated a PrEP project in Mysore, India. We conducted a project ethnography to explore the role that community participation played within the project. Although the project proved immensely successful in terms of retention and adherence, to explain these findings we point towards Ashodaya’s history of collectivisation around sexual health—a history of community action that has given rise to new spaces of belonging and accumulated knowledges that became instrumental in the formulation of strategies to confront anticipated challenges during the project. These strategies included: (1) the participation of community leaders as the first participants to take PrEP, followed by the sharing of their experiences through testimonials to their peers; (2) the endorsement of PrEP among community leaders living with HIV, to avoid social divisions around HIV status; and (3) ongoing community-level support from outreach workers that went beyond administering PrEP to address the various needs of the community. These community-led approaches demonstrate that communities hold key insights into the delivery of clinically-oriented interventions, suggesting the vital role they continue to play in planning and implementing new prevention technologies.