Community mobilisation approaches to preventing and reducing adolescent multiple risk behaviour: a realist review protocol

Background Adolescent multiple risk behaviour (MRB) continues to be a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, rather than targeting the wider environmental or structural context. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. Despite this, there are gaps in the current literature, theory and implementation that would benefit from a realist approach due to the suitability of this methodology to analysing complex interventions. The objective of this study is to understand ‘how, why, for whom and in what circumstances and time periods’ do community mobilisation interventions work to prevent and/or reduce adolescent multiple risk behaviour. Methods This is a protocol for a realist review. The review will use a six-stage iterative process, guided by the RAMESES framework. We will systematically search PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological Abstracts, from their inception to 2021. Studies will be screened for relevance to the programme theory and included based on a priori eligibility criteria including (1) reporting a community mobilisation intervention (2) targeting two health risk behaviors (3) for adolescent populations. Two independent reviewers will select, screen and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome configurations that contribute to our programme theory. The findings will be synthesised to produce a refined programme theory model. Discussion The goal of this realist review is to identify and refine a programme theory for community mobilisation approaches to the prevention and/or reduction of adolescent multiple risk behaviour. Our aim is that the findings surrounding the programme theory refinement can be used to develop and implement adolescent multiple risk behaviour interventions and maintain collaboration between local policy makers, researchers and community members. Systematic review registration This realist review is registered on the PROSPERO database (registration number: CRD42020205342).

How does social/community mobilisation plan to encourage health seeking behaviour can help mitigate AES related mortality and morbidity in Muzaffarpur district of Bihar, India- An intervention plan approach

ABSTRACT Background: I am pleased to present social/ community mobilization plan for encouraging health seeking behaviour by communities of muzaffarpur district for recurring outbreaks of acute encephalitis syndrome. The recurring outbreaks have taken lives of so many children and a sense of fear is prevailing in the district particularly rural areas. The SCMP plan will be of great help in such situations added with clinical care. The state government and other concerned authorities have made several program cycles which are very intensive and satisfactory but the problem still persist. Objectives: The main objectives and aim is to build new thinking around social & community mobilisation plan (SCMP) to deal with the situation. This plan can be useful for many other situations also if prosecuted in proper way. The SCMP plan application needs integrated approach with community and different sectors involvement to deal with the issue of AES outbreaks. It also involves community training to enhance health seeking behaviour of communities to healthcare. This will prevent delay in reaching at proper time, at proper health facility for proper care. Setting & Design: The spread of technologies enable us to leverage and design transmedia initiatives to resonate key message across relevant audience. Knowledge and evidence based facts will serve as backbone to guide through the principles of SCMP. Materials and methodology SCMP knowledge if disseminated in proper way to communities through seminars, media will prove a milestone in public health strategy to deal with AES and many other diseases. The drive and commitment of SCMP programme will definitely have a positive impact on lives and well being of children’s. Results: Since this is an intervention plan the results will be available only if this intervention plan gets ethical approval, adoption and green signal from policy makers and concerned authorities for implementation. Conclusion: It’s my conclusion as well as recommendation that if clinical approaches (medicine and surgery) are unable to solve the healthcare problems we should look at community approach to deal with situations like AES at muzaffarpur, Bihar, India. The world population is growing every second and it’s quite difficult to cater the needs of healthcare on individual basis. Hence advocacy for social and community mobilisation to improve health seeking behaviour should be considered strongly to cater the needs of community.Key words- SCMP, AES, community, mobilisation

Community mobilisation approaches to preventing and reducing adolescent multiple risk behaviour: a realist review protocol

Background: Adolescent multiple risk behaviour (MRB) continues to be a global health issue, contributing to the burden of non-communicable diseases. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, rather than targeting the wider environmental or structural context. There is increasing recognition that community mobilisation approaches that extend beyond individually-focused educational programmes could be beneficial for adolescent health. Despite this, there are gaps in the current literature, theory and implementation that would benefit from a realist approach due to the suitability of this methodology to analysing complex interventions. In this protocol, we outline our study that aims to understand how, why, for whom and in what circumstances and time periods do community mobilisation interventions work to prevent and/or reduce adolescent multiple risk behaviour? Methods: A realist review was chosen as the most suitable review method as it is theory-driven and seeks to understand how, why and for whom interventions work to produce intended and unintended outcomes. A six-stage iterative process is outlined, which includes initial development of a programme theory, systematic searching, study selection and appraisal, data extraction and data synthesis. We will engage with stakeholders at different stages in this process to aid the development of the programme theory. Discussion: The goal of this realist review is to identify and refine a programme theory for community mobilisation approaches to the prevention and/or reduction of adolescent multiple risk behaviour. Our aim is that the findings surrounding the programme theory refinement can be used to develop and implement adolescent multiple risk behaviour interventions and maintain collaboration between local policy makers, researchers and community members.

Community health workers’ involvement in the prevention and control of non-communicable diseases in Wakiso District, Uganda

Background Community health workers (CHWs) are an important cadre of the global health workforce as they are involved in providing health services at the community level. However, evidence on the role of CHWs in delivering interventions for non-communicable diseases (NCDs) in Uganda is limited. This study, therefore, assessed the involvement of CHWs in the prevention and control of NCDs in Wakiso District, Uganda with a focus on their knowledge, attitudes and practices, as well as community perceptions. Methods A cross-sectional study using mixed methods was conducted which involved a structured questionnaire among 485 CHWs, and 6 focus group discussions (FGDs) among community members. The study assessed knowledge, perceptions including the importance of the various risk factors, and the current involvement of CHWs in NCDs, including the challenges they faced. Quantitative data were analysed in STATA version 13.0 while thematic analysis was used for the qualitative data. Results The majority of CHWs (75.3%) correctly defined what NCDs are. Among CHWs who knew examples of NCDs (87.4%), the majority mentioned high blood pressure (77.1%), diabetes (73.4%) and cancer (63.0%). Many CHWs said that healthy diet (86.2%), physical activity (77.7%), avoiding smoking/tobacco use (70.9%), and limiting alcohol consumption (63.7%) were very important to prevent NCDs. Although more than half of the CHWs (63.1%) reported being involved in NCDs activities, only 20.9 and 20.6% had participated in community mobilisation and referral of patients respectively. The majority of CHWs (80.1%) who were involved in NCDs prevention and control reported challenges including inadequate knowledge (58.4%), lack of training (37.6%), and negative community perception towards NCDs (35.1%). From the FGDs, community members were concerned that CHWs did not have enough training on NCDs hence lacked enough information. Therefore, the community did not have much confidence in them regarding NCDs, hence rarely consulted them concerning these diseases. Conclusions Despite CHWs having some knowledge on NCDs and their risk factors, their involvement in the prevention and control of the diseases was low. Through enhanced training and community engagement, CHWs can contribute to the prevention and control of NCDs, including health education and community mobilisation.

Sexually transmitted infections (STI) and antenatal care (ANC) clinics in Malawi: effective platforms for improving engagement of men at high HIV risk with voluntary medical male circumcision services

IntroductionVoluntary medical male circumcision (VMMC), an effective HIV prevention programme for men, is implemented in East and Southern Africa. Approximately 50% of VMMC clients are aged below 15 years. More targeted interventions to reach older men and others at higher short-term HIV risk are needed.MethodsWe implemented a quality improvement project testing the effectiveness of an active referral-based VMMC recruitment approach, targeting men attending STI clinics and those escorting partners to antenatal care (ANC) clinics, at Bwaila Hospital in Lilongwe, Malawi. We compared the proportions aged older than 15 years among men who received VMMC following referral from STI and ANC clinics with those among men referred from standard community mobilisation. We also analysed referral cascades to VMMC.ResultsIn total, 330 clients were circumcised after referral from STI (242) and ANC (88) clinics, as compared with 3839 other clients attributed to standard community mobilisation. All clients from ANC and STI clinics were aged over 15 years, as compared with 69% from standard community mobilisation. STI clinics had a higher conversion rate from counselling to VMMC than ANC (12% vs 9%) and a higher contribution to total circumcisions performed at the VMMC clinic (6% vs 2%).ConclusionsIntegrating VMMC recruitment and follow-up in STI and ANC clinics co-located with VMMC services can augment demand creation and targeting of men at risk of HIV, based on age and STI history. This approach can be replicated at least in similar health facilities with ANC and STI services in close proximity to VMMC service delivery.

Fighting COVID-19: social capital and community mobilisation in Hong Kong

PurposeFocussing on the early phase of the COVID-19 outbreak in Hong Kong, when the infection rate was relatively low, this paper aims to explore the role of social capital in fighting the novel coronavirus.Design/methodology/approachThis is a discussion paper that draws evidence from current scholarly literature and other commentaries, government policies and the personal observation of the author. The main conceptual tool used in the study is Szreter and Woolcock (2004) three-dimensional framework of social capital.FindingsThis paper suggests that whilst the experience of fighting SARS as early as 2003 equipped Hong Kong people with adequate knowledge of virus prevention, efforts to control COVID-19 also benefited from social capital developed during the prolonged social protest since 2019. People belonging to the pro-democracy camp took the initiative to deliver facemasks and advocate hygiene measures in Hong Kong, demonstrating strong community mobilisation. This led to the emergence of bonding and bridging social capital (but not linking social capital) in local society, based substantially on similarity in political orientation.Originality/valueThe use of Szreter and Woolcock (2004) three-dimensional framework for examining social capital provides a new perspective on the contribution of social network analysis to coronavirus protective measures.