Abstract / Resumen:

Background: Community participation is a major principle of people centered health systems, with considerable research highlighting its intrinsic value and strategic importance. Existing reviews largely focus on the effectiveness of community participation with less attention to how community participation is supported in health systems intervention research.

Objective: To explore the extent, nature and quality of community participation in health systems intervention research in low- and middle-income countries.

Methodology: We searched for peer-reviewed, English language literature published between January 2000 and May 2012 through four electronic databases. Search terms combined the concepts of community, capability/participation, health systems research and low- and middle-income countries. The initial search yielded 3,092 articles, of which 260 articles with more than nominal community participation were identified and included. We further excluded 104 articles due to lower levels of community participation across the research cycle and poor description of the process of community participation. Out of the remaining 160 articles with rich community participation, we further examined 64 articles focused on service delivery and governance within health systems research.

Results: Most articles were led by authors in high income countries and many did not consistently list critical aspects of study quality. Articles were most likely to describe community participation in health promotion interventions (78%, 202/260), even though they were less participatory than other health systems areas. Community involvement in governance and supply chain management was less common (12%, 30/260 and 9%, 24/260 respectively), but more participatory. Articles cut across all health conditions and varied by scale and duration, with those that were implemented at national scale or over more than five years being mainstreamed by government. Most articles detailed improvements in service availability, accessibility and acceptability, with fewer efforts focused on quality, and few designs able to measure impact on health outcomes. With regards to participation, most articles supported community’s in implementing interventions (95%, n = 247/260), in contrast to involving communities in identifying and defining problems (18%, n = 46/260). Many articles did not discuss who in communities participated, with just over a half of the articles disaggregating any information by sex. Articles were largely under theorized, and only five mentioned power or control. Majority of the articles (57/64) described community participation processes as being collaborative with fewer describing either community mobilization or community empowerment. Intrinsic individual motivations, community-level trust, strong external linkages, and supportive institutional processes facilitated community participation, while lack of training, interest and information, along with weak financial sustainability were challenges. Supportive contextual factors included decentralization reforms and engagement with social movements.

Conclusion: Despite positive examples, community participation in health systems interventions was variable, with few being truly community directed. Future research should more thoroughly engage with community participation theory, recognize the power relations inherent in community participation, and be more realistic as to how much communities can participate and cognizant of who decides that.

Keywords / Palabras clave:

Health Systems; Community Participation; Research in Health; Low- and middle-income Countries

How to obtain this paper / Como obtener este artículo: click here.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141091

Visit the Portal/Blog of the PAHO/WHO Equity List & Knowledge network : http://equity.bvsalud.org/

Visite el Sítio/Blog de la Lista de Equidad y Red de Conocimiento: : http://equity.bvsalud.org/es/

Community Participation in Health Systems Research: A Systematic Review Assessing the State of Research, the Nature of Interventions Involved and the Features of Engagement with Communities

Asha S. George, Vrinda Mehra, Kerry Scott, Veena Sriram

PLOS One, 2015, 10(10): e0141091

Published online: 23 October 2015

ABSTRACT

Background: Health care professionals are utilizing Twitter to communicate, develop disease surveillance systems, and mine health-related information. The immediate users of this health information is the general public, including patients. This necessitates the validation of health-related tweets by health care professionals to ensure they are evidence based and to avoid the use of noncredible information as a basis for critical decisions.

Objective: The aim of this study was to evaluate health-related tweets on Twitter for validity (evidence based) and to create awareness in the community regarding the importance of evidence-based health-related tweets.

Methods: All tweets containing health-related information in the Arabic language posted April 1-5, 2015, were mined from Twitter. The tweets were classified based on popularity, activity, interaction, and frequency to obtain 25 Twitter accounts (8 physician accounts, 10 nonofficial health institute accounts, 4 dietitian accounts, and 3 government institute accounts) and 625 tweets. These tweets were evaluated by 3 American Board?certified medical coonsultants and a score was generated (true/false) and interobserver agreement was calculated.

Results: A total of 625 health-related Arabic-language tweets were identified from 8 physician accounts, 10 nonofficial health institute accounts, 4 dietician accounts, and 3 government institute accounts. The reviewers labeled 320 (51.2%) tweets as false and 305 (48.8%) tweets as true. Comparative analysis of tweets by account type showed 60 of 75 (80%) tweets by government institutes, 124 of 201 (61.7%) tweets by physicians, and 42 of 101 (41.6%) tweets by dieticians were true. The interobserver agreement was moderate (range 0.78-0.22). More than half of the health-related tweets (169/248, 68.1%) from nonofficial health institutes and dietician accounts (59/101, 58.4%) were false. Tweets by the physicians were more likely to be rated “true” compared to other groups (P<.001).

Conclusions: Approximately half of the medical tweets from professional accounts on Twitter were found to be false based on expert review. Furthermore, most of the evidence-based health-related tweets are posted by government institutes and physicians

SELECTED EXTRACTS (selected by Neil PW)

‘A study that investigated all posts with the words “Ebola” and “prevention” or “cure” from Guinea, Liberia, and Nigeria showed that the most common misinformation was that Ebola might be cured by the plant ewedu or by blood transfusion’

‘A study in 2010 investigated status updated from 52,153 tweets with the combination “flu + antibiotics” and “cold + antibiotics” associated with misinformation. Results showed a total of 172,571 and 850,375 followers of misinformation, respectively, for the 2 combinations.’

‘Twitter is an online minefield of health-related information, which can considerably affect patient health.’

‘Furthermore, a group needs to be created including government institutes, physicians, other health care professionals, and researchers to ensure that online health care resources are current, credible, and reliable for patient use. This information should be available in a format that is user-friendly, comprehensible, and easily accessible.’

Below is the citation, abstract and selected extracts of an interesting paper in the Journal of Medical Internat Research. The authors comclude that ‘Twitter is an online minefield of health-related information, which can considerably affect patient health.’

CITATION: Alnemer KA, Alhuzaim WM, Alnemer AA, Alharbi BB, Bawazir AS, Barayyan OR, Balaraj FK

Are Health-Related Tweets Evidence Based? Review and Analysis of Health-Related Tweets on Twitter

J Med Internet Res 2015;17(10):e246

DOI: 10.2196/jmir.4898

Email: alnemerk [at] hotmail.com

—

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

ABSTRACT

Background: Social media, including mobile technologies and social networking sites, are being used increasingly as part of human immunodeficiency virus (HIV) prevention and treatment efforts. As an important avenue for communication about HIV, social media use may continue to increase and become more widespread.

Objective: The objective of this paper is to present a comprehensive systematic review of the current published literature on the design, users, benefits, and limitations of using social media to communicate about HIV prevention and treatment.

Methods: This review paper used a systematic approach to survey all literature published before February 2014 using 7 electronic databases and a manual search. The inclusion criteria were (1) primary focus on communication/interaction about HIV/acquired immunodeficiency syndrome (AIDS), (2) discusses the use of social media to facilitate communication, (3) communication on the social media platform is between individuals or a group of individuals rather than the use of preset, automated responses from a platform, (4) published before February 19, 2014, and (5) all study designs.

Results: The search identified 35 original research studies. Thirty studies had low or unclear risk of at least one of the bias items in the methodological quality assessment. Among the 8 social media platform types described, short message service text messaging was most commonly used. Platforms served multiple purposes including disseminating health information, conducting health promotion, sharing experiences, providing social support, and promoting medication adherence. Social media users were diverse in geographic location and race/ethnicity; studies commonly reported users aged 18-40 years and users with lower income. Although most studies did not specify whether use was anonymous, studies reported the importance of anonymity in social media use to communicate about HIV largely due to the stigma associated with HIV. The ability to share and receive information about HIV was the most commonly reported benefit of social media use and the most common challenges were related to technology. Measures of frequency of use, satisfaction, and effects of use varied across studies.

Conclusions: Using social media to bridge communication among a diverse range of users, in various geographic and social contexts, may be leveraged through pre-existing platforms and with attention to the roles of anonymity and confidentiality in communication about HIV prevention and treatment. More robust research is needed to determine the effects of social media use on various health and social outcomes related to HIV.

See citation and abstract below of a new paper in the Journal of Medical Internet Research. Full text: http://www.jmir.org/2015/11/e248/

‘Our review shows that social media is a promising approach to engage individuals in a dynamic discourse about HIV prevention and treatment, and may allow diverse groups to collaborate on strategies to address the epidemic’. Importantly, the authors concede (in the full text) that ‘our review was not designed to assess the quality of the information being shared on social media’.

CITATION: Social Media and HIV: A Systematic Review of Uses of Social Media in HIV Communication

Taggart T, Grewe ME, Conserve DF, Gliwa C, Roman Isler M

J Med Internet Res 2015;17(11):e248

DOI: 10.2196/jmir.4387

Email: ttaggart [at] email.unc.edu

—

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

More

As we have discussed here on HIFA during September, the achievement of the new global health targets (SDG3) is fundamentally dependent on a common understanding of how they are defined (which is clear for some targets but not others), and agreement on how progress will be measured. I was interested to learn how far nation states have agreed on indicators for the SDGs, and particularly for SDG 3.

Following a high-level meeting, a document has been released, listing indicators against each SDG target, colour-coded as follows:

‘GREEN: Indicators for which there is general agreement (or small modifications proposed), based on the fact that less than 25% of

respondents have strong concerns/expressed need to discuss on priority basis; no strong opposing views by members; furthermore, some of

these indicators are already well established;

YELLOW: Indicators where there are some unresolved issues or different alternative proposals, which could be resolved during the meeting;

GREY: Indicators where it appears that more in-depth discussion is still needed and/or methodological development needs to be undertaken.’

Please see the document here:

http://bit.ly/1RWXIux

You will note that there is a high level of agreement for most of the SDG 3 indicators. However, the indicators for one of the critical targets – target 3.8 Universl Health Coverage – is colour-coded grey. The original proposed indicators under discussion for this target are ‘Coverage of tracer interventions (e.g. child full immunization, ARV therapy, TB treatment, hypertension treatment, skilled attendant at birth, etc.)’

A public consultation on the green indicators (but not the yellow/grey ones) has been opened here:

http://unstats.un.org/sdgs/iaeg-sdgs/open-consultation-2

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

ABSTRACT

The potential for academic research institutions to facilitate knowledge exchange and influence evidence-informed decision-making has been gaining ground. Schools of public health (SPHs) may play a key knowledge brokering role—serving as agencies of and for development. Understanding academic-policymaker networks can facilitate the enhancement of links between policymakers and academic faculty at SPHs, as well as assist in identifying academic knowledge brokers (KBs). Using a census approach, we administered a sociometric survey to academic faculty across six SPHs in Kenya to construct academic-policymaker networks. We identified academic KBs using social network analysis (SNA) in a two-step approach:

First, we ranked individuals based on (1) number of policymakers in their network; (2) number of academic peers who report seeking them out for advice on knowledge translation and (3) their network position as ‘inter-group connectors’. Second, we triangulated the three scores and re-ranked individuals. Academic faculty scoring within the top decile across all three measures were classified as KBs.

Results indicate that each SPH commands a variety of unique as well as overlapping relationships with national ministries in Kenya. Of 124 full-time faculty, we identified 7 KBs in 4 of the 6 SPHs. Those scoring high on the first measure were not necessarily the same individuals scoring high on the second. KBs were also situated in a wide range along the ‘connector/betweenness’ measure. We propose that a composite score rather than traditional ‘betweenness centrality’, provides an alternative means of identifying KBs within these networks.

In conclusion, SNA is a valuable tool for identifying academic-policymaker networks in Kenya. More efforts to conduct similar network studies would permit SPH leadership to identify existing linkages between faculty and policymakers, shared linkages with other SPHs and gaps so as to contribute to evidence-informed health policies.

KEY MESSAGES

There exist Kenyan academic faculty at schools of public health (SPH) who engage in activities and relationships that place them in unique positions as knowledge brokers and conduits for policy influence.

Using social network analysis to identify knowledge brokers can provide insight into who the advisors/resource persons for faculty in the SPHs are, who have relationships with policy makers, who can be supported and leveraged for bridging the research to policy (and vice versa) divide and which members can convene to collectively influence public health policy.

More efforts to conduct similar network studies would permit leadership at SPHs as well as government policymakers to identify existing linkages between faculty and policymakers, shared linkages with other SPHs and gaps so as to contribute to evidence-informed health policies.

SELECTED EXTRACTS

Researchers and decision-makers are often characterized as ‘distinct communities’ whose infrequent interaction, varied priorities and incongruent timelines, amongst others, impede the flow of evidence (Innvaer et al. 2002)… One way to narrow the gap between researchers and decision-makers is to find and maintain opportunities for interaction.

Academic networks, like policy networks, are nebulous and therefore difficult to assess. Relationships are likely to be informal and dynamic in nature.

National government could utilize recurrent SNA studies to: identify the location and distribution of academic expertise in a country; leverage existing relations for the purposes of influencing health systems research and policy decisions; build strategic networks in areas where gaps exist and understand shared interests for the purposes of engaging in multidisciplinary and multi-sectoral governmental collaborations.

Below are the citation and abstract of a new paper in Health Policy and Planning. The full text is freely available here:

http://heapol.oxfordjournals.org/content/early/2015/11/03/heapol.czv107.full

CITATION: Do academic knowledge brokers exist? Using social network analysis to explore academic research-to-policy networks from six schools of public health in Kenya. Nasreen S. Jessani, Marc G. Boulay and Sara C. Bennett

Health Policy Plan. (2015)

doi: 10.1093/heapol/czv107

Corresponding author. 615 N Wolfe Street, E8132 Baltimore, Maryland 21205. USA. E-mail: njessani@jhu.edu

WORD-OF-MOUTH MESSAGES FROM FRIENDS AND COLLEAGUES ARE ALMOST ALWAYS BETTER RECEIVED THAN BLASTS FROM CORPORATE ACCOUNTS…..more

The average US employee spends about a quarter of the work week combing through the hundreds of emails we all send and receive every day. But despite the fact that we’re glued to our reply buttons, career coach Barbara Pachter says plenty of professionals still don’t know how to use email appropriately. …..more

Heads are likely to roll at the Health Professions Council of SA (HPCSA) after a ministerial task team found its three top officials were “unfit” to hold their positions…..more

‘If you asked a member of the public “Should researchers review relevant, existing research systematically before embarking on further research?” they would probably be puzzled. Why would you ask a question with such an obvious answer? But in the current research system, researchers are only rarely required by research funders and regulators to do this.’

‘The most extensive relevant analysis found that published reports of trials cited fewer than 25% of previous similar trials. Furthermore, many researchers appear unaware of existing systematic reviews of research….’

Below are extracts of a new blog by Paul Glasziou and Iain Chalmers in the BMJ. The full text is available here: http://blogs.bmj.com/bmj/2015/10/29/how-systematic-reviews-can-reduce-waste-in-research/

The authors quote from the National Institute for Health Research:

“Where a systematic review already exists that summarises the available evidence this should be referenced, as well as including reference to any relevant literature published subsequent to that systematic review. Where no such systematic review exists it is expected that the applicants will undertake an appropriate review of the currently available and relevant evidence.”

I would like to ask HIFA members: What can be done to address this problem? How can researchers be encouraged to make their own research ‘evidence-based’ (taking account of previous similar research, especially systematic reviews, and undertaking a systematic review where one does not already exist)? Is it not time for funding agencies and governments – and ethics committees – to insist that all research should be preceded by a review of available evidence before it is approved? This is indeed an ethical issue – we are talking about the potential for unnecessary trials causing harm to patients, not to mention the huge waste of public spending on research that should never have been done.  

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

I welcome you to this second annual report from WONCA, our World Organization of Family Doctors. This report has been produced to keep our Member Organizations, our Direct Members, and other interested organisations and individuals, informed about WONCA’s activities over the past year. This report outlines the highlights of the work of your elected executive members, and our CEO and secretariat staff, and our Young Doctor Movements, working parties, special interest groups and individual representatives over the past year. It also includes our 2014 annual financial statement and auditor’s report. This report provides a snapshot of the huge amount of work that is carried out by WONCA and our members around the world. More news and details can be found on our WONCA website – http://www.globalfamilydoctor.com – and you are invited to sign up for our weekly email updates on the activities of our global organization. Your WONCA executive has three main goals for the 2013-2016 triennium…. More

The recent situation of rapid and unplanned migration in Europe has raised my awareness of a situation which many other regions have already experienced. The WONCA Europe conference saw the launch of the ‘Istanbul statement’ on refugee health, and much discussion both within workshops and plenaries about the needs and challenges for family doctors. The very active special interest group (SIG) on migrant care hosted two workshops on refugee and migrant child health, and Prof Jan de Maeseneer in his plenary challenged WONCA to add to these initiatives with policy and evidence on good practice. Another group launched at WONCA Europe was the ‘WONCA SIG on Conflict and Catastrophe medicine’, whose remit also relates to this area….more

WONCA News – October 2015

The latest WONCA News, containing the usual mix of WONCA news, views and events, is available via the WONCA website.

October’s Policy Bite

This month’s policy bite is authored by Dr Luisa Pettigrew.  Luisa is a member of the WONCA Executive and is our Liaison Person with the WHO.  She discusses the challenges of measuring outcomes in relation to the new Sustainable Development Goals and talks about WONCA’s inputs into the process.  

Featured doctors

Two more interesting doctors are featured in WONCA News this month.

Professor Rich Withnall of UK is Convener of the WONCA Special Interest Group on Conflict and Catastrophe Medicine.  Find out more about Rich, and about the activities of the SIG he leads.   

A/Professor Roar Maagaard of Denmark is Chair of the Host Organizing Committee for the 2016 WONCA Europe conference in Copenhagen.  Next month’s WONCA News will have more details of that conference, but for now you can find out more about the man himself. 

Future WONCA Conferences

Whilst Roar will tell us more about Copenhagen 2016 next month, and whilst many of us are heading to Istanbul for this year’s WONCA Europe conference, we’d like to highlight some other WONCA regional conferences scheduled for the first part of 2016.  Of course details of all WONCA conferences can be found by clicking on the “conferences” link above.

WONCA South Asia Region – in Colombo, Sri Lanka, on 13th and 14th February 2016, and pre-conference on 12th February.  The theme of the conference is “Reaching across the shores to strengthen Primary Care” and abstract submission is now open.  For more details of this event go to the WONCA website.

WONCA Eastern Mediterranean Region – in Dubai from 17th to 19th March, with the Al Razi (EMR young doctor movement) pre-conference on 16th March.  More details are available from the WONCA website. The call for abstracts has gone out, and more details can be found from the website.

See here

NEW YORK, 26 September 2015 – Underscoring the urgent need to transform how essential health care is delivered in low- and middle-income countries, the Bill & Melinda Gates Foundation, World Bank Group and World Health Organization today launched a new partnership to support countries in improving the performance of primary health care. Primary health care is the pillar of health systems and is central to preventing epidemics like Ebola; improving women’s and children’s health; controlling major infectious diseases, such as HIV and TB; and managing the rising burden of non-communicable diseases, such as heart disease and cancer…..more

For about a decade now, policy makers and the soda industry have been fighting about the idea of a big soda tax. Proponents say it would fight obesity by reducing consumption of sugary drinks. A leading objection by the industry is that the tax simply would not work…..more

Many countries have identified primary health care (PHC) as an urgent priority, but they lack comprehensive data to pinpoint specific weaknesses, understand their causes, and strategically direct resources to address them. Health system managers typically have data on inputs such as total number of health workers, medicines, and supplies available. They also measure outputs like the percent of children vaccinated and the percent of pregnant women who deliver in facilities. These are crucial to measure, but they are not sufficient…..more

All about PHCPI and Indicators

The Gauteng Association for Infant Mental Health (GAIMH) in collaboration with the University of the Witwatersrand, Johannesburg and the Centre of Excellence is hosting a conference titled “The bodies and minds of babies in relationship: Dialogues in a multidisciplinary context”. The aim of the conference is to establish greater awareness around infant mental health and to highlight the multidisciplinary nature of the field.

• GAIMH conference pitch October 2015
• GAIMH-Shabir-WONCA
• GAIMH-SA Conference programme printable

Health plans, employers, and state governments increasingly expect Americans to use information about pricing when making health care decisions. After all, the more consumers know about pricing, the better they can budget for out-of-pocket expenses and for routine costs related to chronic conditions, the more intelligently they can choose among providers, and the more easily they can bring pricing information directly into conversations with those providers. Those conversations can lead to more sensible decision making about care, avoiding costly tests and procedures that are unlikely to improve health outcomes. Consumers who are especially knowledgeable and motivated can even negotiate what they will pay for services at their preferred health care facilities,as some anecdotal evidence has shown….more

This 46-page document aims to guide the implementation of health promotion programmes in South Africa….more