Enhanced Community Engagement Research Articles

Effectiveness of a collaborative model in improving maternal and child health outcomes among urban poor in Chandigarh, a North Indian city.

BACKGROUND:To ascertain the effectiveness of a collaborative model between the Department of Community Medicine and state health department to improve MCH outcomes among the urban poor in Chandigarh.MATERIALS AND METHODS:A quasi-experimental study was conducted from 2011–12 to 2015–16 in the intervention and control areas. A collaboration was established between the state health department and the Department of Community Medicine of an autonomous institute. The intervention and control areas were mainly inhabited by the poor migrant population. Critical elements of an efficient collaboration such as the early engagement of partners, clearly stated purpose with common goals, effective communication, and no financial conflict were implemented in the intervention area. MCH program's implementation was strengthened through supportive supervision, enhanced community engagement, male partner involvement, tracking of high-risk pregnant women, and identification of problem families. Trend analysis of MCH indicators was done. The difference-in-difference (DID) analysis was done to measure the net effect of the intervention.RESULTS:All the MCH indicators improved significantly in the intervention area compared to the control area (P < 0.05). DID analysis depicted a net increase in the early registration of pregnancies by 18%, tetanus toxoid immunization by 9.2%, and fully immunized children by 8.6%. There was also an improvement in the maternal mortality ratio by 121.1 points, infant mortality rate by 2.2 points, and neonatal mortality rate by 2.6 points in the intervention area.CONCLUSION:An innovative, collaborative model between the state health department and the Department of Community Medicine effectively improved the MCH outcomes in Chandigarh.

Decentralized facility financing versus performance-based payments in primary health care: a large-scale randomized controlled trial in Nigeria

BackgroundHealth system financing presents a challenge in many developing countries. We assessed two reform packages, performance-based financing (PBF) and direct facility financing (DFF), against each other and business-as-usual for maternal and child healthcare (MCH) provision in Nigeria.MethodsWe sampled 571 facilities (269 in PBF; 302 in DFF) in 52 districts randomly assigned to PBF or DFF, and 215 facilities in 25 observable-matched control districts. PBF facilities received $2 ($1 for operating grants plus $1 for bonuses) for every $1 received by DFF facilities (operating grants alone). Both received autonomy, supervision, and enhanced community engagement, isolating the impact of additional performance-linked facility and health worker payments. Facilities and households with recent pregnancies in facility catchments were surveyed at baseline (2014) and endline (2017). Outcomes were Penta3 immunization, institutional deliveries, modern contraceptive prevalence rate (mCPR), four-plus antenatal care (ANC) visits, insecticide-treated mosquito net (ITN) use by under-fives, and directly observed quality of care (QOC). We estimated difference-in-differences with state fixed effects and clustered standard errors.ResultsPBF increased institutional deliveries by 10% points over DFF and 7% over business-as-usual (p<0.01). PBF and DFF were more effective than business-as-usual for Penta3 (p<0.05 and p<0.01, respectively); PBF also for mCPR (p<0.05). Twenty-one of 26 QOC indicators improved in both PBF and DFF relative to business-as-usual (p<0.05). However, except for deliveries, PBF was as or less effective than DFF: Penta3 immunization and ITN use were each 6% less than DFF (p<0.1 for both) and QOC gains were also comparable. Utilization gains come from the middle of the rural wealth distribution (p<0.05).ConclusionsOur findings show that both PBF and DFF represent significant improvements over business-as-usual for service provision and quality of care. However, except for institutional delivery, PBF and DFF do not differ from each other despite PBF disbursing $2 for every dollar disbursed by DFF. These findings highlight the importance of direct facility financing and decentralization in improving PHC and suggest potential complementarities between the two approaches in strengthening MCH service delivery.Trial registrationClinicalTrials.gov NCT03890653; May 8, 2017. Retrospectively registered.

Lessons Learned From COVID-19 Contact Tracing During a Public Health Emergency: A Prospective Implementation Study.

Background: Contact tracing is a core element of the public health response to emerging infectious diseases including COVID-19. Better understanding the implementation context of contact tracing for pandemics, including individual- and systems-level predictors of success, is critical to preparing for future epidemics.Methods: We carried out a prospective implementation study of an emergency volunteer contact tracing program established in New Haven, Connecticut between April 4 and May 19, 2020. We assessed the yield and timeliness of case and contact outreach in reference to CDC benchmarks, and identified individual and programmatic predictors of successful implementation using multivariable regression models. We synthesized our findings using the RE-AIM implementation framework.Results: Case investigators interviewed only 826 (48%) of 1,705 cases and were unable to reach 545 (32%) because of incomplete information and 334 (20%) who missed or declined repeated outreach calls. Contact notifiers reached just 687 (28%) of 2,437 reported contacts, and were unable to reach 1,597 (66%) with incomplete information and 153 (6%) who missed or declined repeated outreach calls. The median time-to-case-interview was 5 days and time-to-contact-notification 8 days. However, among notified contacts with complete time data, 457 (71%) were reached within 6 days of exposure. The least likely groups to be interviewed were elderly (adjusted relative risk, aRR 0.74, 95% CI 0.61–0.89, p = 0.012, vs. young adult) and Black/African-American cases (aRR 0.88, 95% CI 0.80–0.97, pairwise p = 0.01, vs. Hispanic/Latinx). However, ties between cases and their contacts strongly influenced contact notification success (Intraclass Correlation Coefficient (ICC) 0.60). Surging caseloads and high volunteer turnover (case investigator n = 144, median time from sign-up to retirement from program was 4 weeks) required the program to supplement the volunteer workforce with paid public health nurses.Conclusions: An emergency volunteer-run contact tracing program fell short of CDC benchmarks for time and yield, largely due to difficulty collecting the information required for outreach to cases and contacts. To improve uptake, contact tracing programs must professionalize the workforce; better integrate testing and tracing services; capitalize on positive social influences between cases and contacts; and address racial and age-related disparities through enhanced community engagement.

What gaps remain in the HIV cascade of care? Results of a population-based survey in Nsanje District, Malawi.

IntroductionThe Malawi Ministry of Health (MoH) has been in collaboration with Médecins sans Frontières (MSF) to increase access to quality HIV care through decentralization of antiretroviral therapy (ART) diagnosis and treatment from hospital to clinics in Nsanje District since 2011. A population-based household survey was implemented to provide information on HIV prevalence and cascade of care to inform and prioritize community-based HIV interventions in the district.MethodsA cross-sectional survey was conducted between September 2016 and January 2017. Using two-stage cluster sampling, eligible adult individuals aged ≥15 years living in the selected households were asked to participate. Participants were interviewed and tested for HIV at home. Those tested HIV-positive had their HIV-RNA viral load (VL) measured, regardless of their ART status. All participants tested HIV-positive at the time of the survey were advised to report their HIV test result to the health facility of their choice that MSF was supported in the district. HIV-RNA VL results were made available in this health facility.ResultsAmong 5,315 eligible individuals, 91.1% were included in the survey and accepted an HIV test. The overall prevalence was 12.1% (95% Confidence Interval (CI): 11.2–13.0) and was higher in women than in men: 14.0% versus 9.5%, P<0.001. Overall HIV-positive status awareness was 80.0% (95%CI: 76.4–83.1) and was associated with sex (P<0.05). Linkage to care was 78.0% (95%CI: 74.3–81.2) and participants in care 76.2% (95%CI: 72.4–79.5). ART coverage among participants aware of their HIV-positive status was 95.3% (95%CI: 92.9–96.9) and was not associated with sex (P = 0.55). Viral load suppression among participants on ART was 89.9% (95%CI: 86.6–92.4) and was not statistically different by sex (p = 0.40).ConclusionsDespite encouraging results in HIV testing coverage, cascade of care, and UNAIDS targets in Nsanje District, some gap remains in the first 90, specifically among men and young adults. Enhanced community engagement and new strategies of testing, such as index testing, could be implemented to identify those who are still undiagnosed, particularly men and young adults.

Community engagement strategy for increased uptake of routine immunization and select perinatal services in north-west Ethiopia: A descriptive analysis.

BackgroundRoutine immunization coverage has stagnated over the past decade and fallen short of WHO targets in Ethiopia. Community engagement strategies that reach beyond traditional health systems may reduce dropout and increase coverage. This evaluation assesses changes in immunization, postpartum family planning, and antenatal care coverage after implementation of an enhanced community engagement and defaulter tracing strategy, entitled “Fifth Child” project, across two districts in Benishangul-Gumuz Regional State (BGRS), Ethiopia.Methods and findingsA formative evaluation was conducted to examine the contribution of the strategy on immunization, postpartum family planning and antenatal care utilization in Assosa and Bambasi districts of BGRS. The quantitative findings are presented here. Routine and project-specific data were analyzed to assess changes in uptake of childhood vaccinations, postpartum family planning and antenatal care. Between January 2013 and December 2016, pentavalent-3 coverage increased from 63% to 84% in Assosa, and from 78% to 93% in Bambasi. Similarly, measles vaccine coverage increased from 77% to 81% in Assosa, and from 59% to 86% in Bambasi. Approximately 54% of all eligible infants across both woredas defaulted on scheduled vaccinations at least once during the period. Among defaulting children, 84% were identified and subsequently caught up on the vaccinations missed. Secondary outcomes of postpartum family planning and antenatal care also increased in both woredas.ConclusionThe “Fifth Child” project likely contributed to enhanced immunization performance and increased utilization of immunization and select perinatal health services in two woredas of BGRS. Further research is required in order to determine the impact of this community engagement strategy.

Primary health care and sustainable development goals.

We examine the potential and limitations of primary health care in contributing to the achievement of the health-related sustainable development goals (SDGs), and recommend policies to enable a functioning primary health-care system. Governments have recently reaffirmed their commitment to the SDGs through the 2018 Declaration of Astana, which redefines the three functions of primary health care as: service provision, multisectoral actions and the empowerment of citizens. In other words, the health-related SDGs cannot be achieved by the provision of health-care services alone. Some health issues are related to environment, necessitating joint efforts between local, national and international partners; other issues require public awareness (health literacy) of preventable illnesses. However, the provision of primary health care, and hence achievement of the SDGs, is hampered by several issues. First, inadequate government spending on health is exacerbated by the small proportions allocated to primary health care. Second, the shortage and maldistribution of the health workforce, and chronic absenteeism in some countries, has led to a situation in which staffing levels are inversely related to poverty and need. Third, the health workforce is not trained in multisectoral actions, and already experiences workloads of an overwhelming nature. Finally, health illiteracy is common among the population, even in developed countries. We recommend that governments increase spending on health and primary health care, implement interventions to retain the rural health workforce, and update the pre-service training curricula of personnel to include skills in multisectoral collaboration and enhanced community engagement.

Abstract A023: Results from a town hall meeting: Inflammatory breast cancer listening session led by KOMEN scholars

Abstract Introduction: Cancer is the leading cause of death in North Carolina. While the incidence rate of breast cancer (BC) is higher in White women, African American and Latino women are more likely to die from BC than White women. Moreover, inflammatory breast cancer (IBC) is a rare and aggressive form of BC, and African Americans are more likely to be diagnosed with IBC compared to whites, have poor BC outcomes, and generally are less likely to get life-saving information and resources to reduce cancer risks. Additionally, work is needed to improve diagnosis rates and decrease time to treatment for IBC patients. Translational research scientists do not get exposure to community engagement opportunities that can add to their knowledge of the research spectrum around a particular disease. Engaging new researchers in this arena can add to addressing cancer disparities research. Methods: An IBC listening session was conducted during the annual Women's Health Awareness Day conference sponsored by the National Institute of Environmental Health Sciences and North Carolina Central University. The session was developed by KOMEN translational health disparities researchers as part of their enhanced community engagement training program. Scholars created the marketing plan and listening session guide for the program with guidance and training from staff experts. Scholars were note takers, facilitators, and created summary reports that highlighted guiding questions for the session, which included the following questions: 1)What do you know about BC? 2) Are you aware of different types of breast cancers? 3) Have you heard of IBC? 4) How aware do you think people in your community are about BC and IBC? 5) Where do you get your information about BC and IBC? 6) What are ways we should educate the community with getting information on how to become aware about the signs and symptoms of IBC? Results: There were 49 African American and Latina participants. Only 15 of 49 attendees had heard of IBC. Most women were aware of causes and symptoms of breast cancer; however, there was a lack of awareness around IBC. Those aware of IBC learned about it from their coworkers, doctors, or had family members die from the disease. Participants recommended more one-on-one education, patient self-advocacy sessions, making education and awareness available online, changing breast cancer communication to include IBC symptoms, and letting people know that you can have breast cancer without the presence of lumps. Conclusion: Poor awareness, communication, and education around inflammatory breast cancer risk factors were substantial. There is significant need to raise awareness in diverse communities about inflammatory breast cancer risks, screening guidelines, diagnosis, and treatment options. Community-engaged research lead by under-represented researcher scholars in training can add to the translational research training experience. Citation Format: Maria Dixion, Kearston L. Ingraham, Seronda A. Robinson, Jodie M. Fleming, Gayathri R. Devi, Holly Hough, Hamzah Kharabsheh, Dana M. Austin, Tia A. Tate, Artis Woodard, Joshua Alexander, Joan P. Packenham, Nadine J. Barrett, Kevin P. Williams. Results from a town hall meeting: Inflammatory breast cancer listening session led by KOMEN scholars [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A023.

The cost of insecurity: from flare-up to control of a major Ebola virus disease hotspot during the outbreak in the Democratic Republic of the Congo, 2019

The ongoing Ebola outbreak in the eastern Democratic Republic of the Congo is facing unprecedented levels of insecurity and violence. We evaluate the likely impact in terms of added transmissibility and cases of major security incidents in the Butembo coordination hub. We also show that despite this additional burden, an adapted response strategy involving enlarged ring vaccination around clusters of cases and enhanced community engagement managed to bring this main hotspot under control.

How can an enhanced community engagement with innovation districts be established? Evidence from Sydney, Melbourne and Brisbane

People's perception about innovation districts are widening. They are now seen not only as a hub for commerce, research and education, but also a node for facilitating recreational, cultural and community-based activities. However, the level of integration of local communities with innovation districts is an understudied area. The paper aims to identify the likely features of innovation districts that can enhance public inclusiveness within this new land use type. This study surveys 1040 participants from three major Australian cities to address the research questions—How can an enhanced community engagement with innovation districts be established? The results reveal that: (a) Currently community engagement with innovation districts is limited to occupational and educational activities; (b) Lack of social coherence between knowledge workers and the public limits community engagement with innovation districts; (c) Advanced amenities, authentic scenes and unique experiences from innovation districts would enhance community engagement. The study informs planning and design policies to improve public engagement in innovation districts.

Digital possibilities in the prevention and early detection of oral cancer in the WHO South-East Asia Region.

Cancers of the lip and oral cavity are the most common cancers among men in the World Health Organization (WHO) South-East Asia Region. Most cancers of the oral cavity are attributable to tobacco smoking, smokeless tobacco use and areca-nut product use, alone or in combination, and excessive consumption of alcohol. These risk factors are highly prevalent in parts of the region. This paper outlines an integrated framework for oral cancer prevention, which includes a strengthened primary health-care workforce, enhanced community engagement and a positive policy environment. Operationalizing this framework could be greatly facilitated by the application of digital technologies. Robust evidence exists for the effectiveness of using appropriately trained primary health-care workers to screen for oral cancer by oral visual examination; this can be combined with counselling for riskbehaviour modification as part of an overall strategy on noncommunicable diseases. This needs to be supported by greater overall community engagement, for example to tackle low levels of awareness of the harmful effects of smokeless tobacco and areca-nut products. A strong policy environment that supports and promotes these efforts is essential, along with the enforcement of the measures required by the WHO Framework Convention on Tobacco Control. Despite the burden of disease, oral cancer has been a neglected area of public health. This paper considers how the positively disruptive effects of digital technology may enable much-needed acceleration in prevention and control efforts.

Strengthening acute flaccid paralysis surveillance post Ebola virus disease outbreak 2015 - 2017: the Liberia experience.

IntroductionLiberia remains at high risk of poliovirus outbreaks due to importation. The country maintained certification level acute flaccid paralysis (AFP) surveillance indicators each year until 2014 due to Ebola outbreak. During this time, there was a significant drop in non-polio AFP rate to (1.2/100,000 population under 15 years) in 2015 from 2.9/100, 000 population in 2013, due to a variety of reasons including suspension on shipment of acute flaccid paralysis stool specimen to the polio regional lab in Abidjan, refocusing of surveillance officers attention solely on Ebola virus disease (EVD) surveillance, inactivation of national polio expert committee (NPEC) and National Certification Committee (NCC). The Ministry of Health (MOH) supported by partners worked to restore AFP surveillance post EVD outbreak and ensure that Liberia maintains its polio free certification.MethodsWe conducted a desk review to summarize key activities conducted to restore acute flaccid paralysis (AFP) surveillance based on World Health Organization (WHO) AFP surveillance guidelines for Africa region. We also reviewed AFP surveillance indicators and introduction of new technologies. Data sources were from program reports, scientific and gray literature, AFP database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel and access spread sheets, ONA software and Geographic Information System (Arc GIS).ResultsAFP surveillance indicators improved with a rebound of non-polio AFP rate (NPAFP) rate from 1.2/100, 000 population under 15 years in 2015 to 4.3 in 2017. The stool adequacy rate at the national level also improved from 79% in 2016 to 82% in 2017, meeting the global target. The percentage of counties meeting the two critical AFP surveillance indicators NPAFP rate and stool adequacy improved from 47% in 2016 to 67% in 2017.The Last polio case reported in Liberia was in late 2010.ConclusionThere was significant improvement in the key AFP surveillance indicators such as NPAFP rate and stool adequacy with a 3.5 fold increase in NPAFP from 2014 to 2017. By 2017, the stool adequacy rate was up to target levels compared to 2016, which was below target level of 80%. The number of counties meeting target for the two critical AFP surveillance indicators also increased by 20% points between 2016 and 2017. Similarly there was approximately two-fold increase in the oral polio vaccines (OPV) coverage for the reported AFP cases between 2015 and 2017. Strategies employed to address gaps in AFP surveillance included enhanced active case search for AFP, re-instatement of laboratory testing, supportive supervision in addition to facilitating enhanced community engagement in surveillance activities. New technologies such as AVADAR Pilot, electronic integrated supportive supervision (ISS) and electronic surveillance (eSurv) tools were introduced to improve real time AFP case reporting. However, there remain residual gaps in AFP surveillance in the country especially at the sub-national level. Similarly, the newly introduced technologies will require continued funding and capacity building for MOH staff to ensure sustainability of the initiatives.

Locating fish bomb blasts in real-time using a networked acoustic system

Results are presented of a demonstration of real-time fish blast location in Sabah, Malaysia using a networked hydroacoustic array based on the ShotSpotter gunshot location system. A total of six acoustic sensors - some fixed and others mobile - were deployed at ranges from 1 to 9 km to detect signals from controlled test blasts. This allowed the blast locations to be determined to within 60 m accuracy, and for the calculated locations to be displayed on a map on designated internet-connected computers within 10 s. A smaller three-sensor system was then installed near Semporna in Eastern Sabah that determined the locations of uncontrolled blasts set off by local fishermen. The success of these demonstrations shows that existing technology can be used to protect reefs and permit more effective management of blast fishing activity through improved detection and enforcement measures and enhanced community engagement.

Surviving bushfire: the role of shelters and sheltering practices during the Black Saturday bushfires

The decision of whether to leave or stay and defend is a well communicated public safety policy for those at risk from bushfire in Australia. Advice relating to sheltering practices during bushfire is less developed. This paper presents findings from a study of sheltering practices during the 2009 Black Saturday bushfires. The study examined the circumstances and challenges experienced by residents when sheltering and/or exiting houses, sheds, and personal bunkers. The analysis considered a number of factors including human behaviour and decision making, house design and construction, the surrounding landscape and fire behaviour.The results show the need for contingency planning and the need for active sheltering, involving regular monitoring of conditions inside and outside the shelter and actions to protect the shelter and its occupants. Also discussed is the tenability and location of the shelters and key questions around how bushfire-related building controls can improve the predictability of shelter failure, reduce the rate of shelter tenability loss and facilitate egress. This research highlights the need for enhanced community engagement and education to encourage residents to plan and prepare for active sheltering.

Community Response and Engagement During Extreme Water Events in Saskatchewan, Canada and Queensland, Australia

Technology alone cannot address the challenges of how societies, communities, and individuals understand water accessibility, water management, and water consumption, particularly under extreme conditions like floods and droughts. At the community level, people are increasingly aware challenges related to responses to and impacts of extreme water events. This research begins with an assessment of social and political capacities of communities in two Commonwealth jurisdictions, Queensland, Australia and Saskatchewan, Canada, in response to major flooding events. The research further reviews how such capacities impact community engagement to address and mitigate risks associated with extreme water events and provides evidence of key gaps in skills, understanding, and agency for addressing impacts at the community level. Secondary data were collected using template analysis to elucidate challenges associated with education (formal and informal), social and political capacity, community ability to respond appropriately, and formal government responses to extreme water events in these two jurisdictions. The results indicate that enhanced community engagement alongside elements of an empowerment model can provide avenues for identifying and addressing community vulnerability to negative impacts of flood and drought.

Science in the Community: A Widening Participation Activity with a Difference!

Primary objective:There is clear evidence that for young people from relatively low socioeconomic backgrounds, science subjects can be invaluable by providing a means by which they can better engage with the modern world and take advantage of the opportunities it affords. For such young people, however, the classroom is not always a welcome environment to hear about science; different approaches are required in order to engage with such individuals. Research design: The Manchester Pharmacy School hosted a Community Open Day event primarily targeting disadvantaged young learners and their families to explore the science behind the drug development process through a range of fun-filled, engaging activities and in so doing, raise awareness of higher education and what it can offer. Active contributions from local schools and drama groups enhanced community engagement. Outcomes and results: Over 300 people attended, two-thirds (71%) of whom were from the local neighbourhood and not associated with the University. Visitor feedback gave the whole event an average Likert scale rating of 3.7 out of a possible 4. The community event was deemed an overwhelming success, providing and enlightened and positive view of higher education, science and pharmaceutical research.

Challenges of being new to Canada: considerations for physical activity.

Immigrants to Canada are less likely to be physically active compared with non-immigrants, and the interrelations between personal and environmental factors that influence physical activity for immigrants are largely unexplored. The goal of this qualitative descriptive study was to understand how the experience of being new to Canada impacts opportunities and participation in physical activity. Two focus group interviews with immigrants to Canada were conducted. The first group ( n=7) included multicultural health brokers. The second group ( n=14) included English as a second language students. Qualitative content analysis was used to determine three themes consistent with the research question: transition to Canadian life, commitments and priorities, and accessibility. Discussion was framed using a social ecological model. Implications for practice and policy are suggested including enhanced community engagement, and organizational modifications. Overall, the development and implementation of physical activity policies and practices for newcomers to Canada should be centered on newcomers' perspectives and experiences.

Participants' Explanations for Nonadherence in the FEM-PrEP Clinical Trial.

FEM-PrEP-a clinical trial of daily, oral emtricitabine/tenofovir disoproxil fumarate for HIV prevention among women in sub-Saharan Africa-did not show a reduction in HIV acquisition because of low adherence to the study pill. We conducted a follow-up study to identify reasons for nonadherence. Qualitative, semistructured interviews (n = 88) and quantitative, audio computer-assisted self-interviews (n = 224) were conducted with former FEM-PrEP participants in Bondo, Kenya, and Pretoria, South Africa. Thematic analysis was used to analyze the qualitative data, and descriptive statistics were used to describe audio computer-assisted self-interviews responses. Data are presented within the 5 categories of Ickovics' and Meisler's conceptual framework on adherence: (1) the individual, (2) trial characteristics and study pill regimen, (3) patient-provider relationship, (4) clinical setting, and (5) the disease. Participants' explanations for nonadherence were primarily situated within 3 of the framework's 5 categories: (1) the individual, (2) trial characteristics and study pill regimen, and (3) the disease. Concerns about the investigational nature of the drug being tested and side effects were the prominent reasons reported for nonadherence. Participants also described being discouraged from taking the study pill by members of the community, their sexual partners, and other participants, primarily because of these same concerns. Limited acceptability of the pill's attributes influenced nonadherence for some participants as did concerns about HIV-related stigma. In addition, many participants reported that others continued in FEM-PrEP while not taking the study pill because of the trial's ancillary benefits and visit reimbursement-factors related to the clinical setting. Negative patient-provider relationships were infrequently reported as a factor that influenced nonadherence. Despite substantial study staff engagement with participants and communities, concerns about the study pill and discouragement from others seemed to have influenced nonadherence considerably. Alternative study designs or procedures and enhanced community engagement paradigms may be needed in future studies.

Importance of community engagement in primary health care: the case of Afghan refugees.

Refugees can experience problems accessing and utilising Australian primary health care services, resulting in suboptimal health outcomes. Little is known about the impact of their pre-migration health care experiences. This paper demonstrates how the Afghan pre-migration experiences of primary health care can affect engagement with Australian primary care services. It considers the implications for Australian primary health care policy, planning and delivery. This paper is based on the international experiences, insights and expert opinions of the authors, and is underpinned by literature on Afghan health-seeking behaviour. Importantly, Afghanistan and Australia have different primary health care strategies. In Afghanistan, health care is predominantly provided through a community-based outreach approach, namely through community health workers residing in the local community. In contrast, the Australian health care system requires client attendance at formal health service facilities. This difference contributes to service access and utilisation problems. Community engagement is essential to bridge the gap between the Afghan community and Australian primary health care services. This can be achieved through the health sector working to strengthen partnerships between Afghan individuals, communities and health services. Enhanced community engagement has the potential to improve the delivery of primary health care to the Afghan community in Australia.

A place to make, hack, and learn: makerspaces in Australian public libraries

Content-creation spaces, or ‘makerspaces’, are an emerging phenomenon in public libraries worldwide. This study investigated the current state of makerspaces in Australian public libraries. Qualitative interviews with three information professionals formed the data collection. Thematic analysis of interviews addressed two research questions: What are the issues and challenges of creating makerspaces within Australian public libraries? How can they be addressed? Findings revealed the substantive benefits of these spaces, including enhanced community engagement, development of a new form of library as ‘third place’, and transforming the library's image from that of a place where works are consumed to that of a place where works are created. Additionally the study highlighted significant challenges to creating these spaces, including budgetary constraints, resistance to change within organisations and proving the relevance of such spaces within a library context. The study provides suggestions for overcoming these obstacles and provides areas for further research in the area, including larger studies across a broader geographic area and further investigation and follow-up into upcoming programs within existing makerspaces.

From Neighbourhood Governance to Neighbourhood Management: A ‘Roll-Out’ Neo-Liberal Design for Devolved Governance in the United Kingdom?

Dominant narratives of neighbourhood working in the United Kingdom accentuate the diversity and ‘messiness’ of practices across local authorities. This paper questions such narratives. Drawing upon a study of 15 local authorities, we first argue that neighbourhood working is increasingly oriented towards neighbourhood management, privileging the ‘joining up’ of mainstream service delivery over the enhanced community engagement and political accountability more associated with the practices of neighbourhood governance. Deploying Lowndes and Sullivan's four rationales of neighbourhood working (2008), in combination with Mintzberg's metaphor of organisation as ‘structure in fives’ (1983), we suggest that the practices of neighbourhood working are currently best understood in terms of Mintzberg's decentralised divisional authority as a form of constrained decentralisation in which semi-autonomous divisions are brought together under a central administration and given limited control over service delivery in order to address the social and economic rationales for neighbourhood working. We then draw upon recent neo-liberal critiques of local governance to offer a critical evaluation of both the appeal for local officers and politicians of neighbourhood management and the potential tensions and contradictions of such a move for future policy and practice. We conclude that neighbourhood management as a neo-liberal ‘roll-out’ strategy may be self-defeating, surfacing the incapacity of local authorities to respond to local community expectations and grievances, whilst exposing the organisational constraints of partnership working, managerialism and outsourcing.