Article Text
PDF
Abstract
Introduction Engaging the community as actors within reproductive, maternal, newborn and child health (RMNCH) programmes (referred to as ‘community blank’) has seen increased implementation in recent years. While evidence suggests these approaches are effective, terminology (such as ‘community engagement,’ ‘community participation,’ ‘community mobilisation,’ and ‘social accountability’) is often used interchangeably across published literature, contributing to a lack of conceptual clarity in practice. The purpose of this review was to describe and clarify varying uses of these terms in the literature by documenting what authors and implementers report they are doing when they use these terms.
Methods Seven academic databases (PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, Global Health), two grey literature databases (OAIster, OpenGrey) and relevant organisation websites were searched for documents that described ‘community blank’ terms in RMNCH interventions. Eligibility criteria included being published between 1975 and 1 October 2021 and reports or studies detailing the activities used in ‘community blank.’
Results A total of 9779 unique documents were retrieved and screened, with 173 included for analysis. Twenty-four distinct ‘community blank’ terms were used across the documents, falling into 11 broader terms. Use of these terms was distributed across time and all six WHO regions, with ‘community mobilisation’, ‘community engagement’ and ‘community participation’ being the most frequently used terms. While 48 unique activities were described, only 25 activities were mentioned more than twice and 19 of these were attributed to at least three different ‘community blank’ terms.
Conclusion Across the literature, there is inconsistency in the usage of ‘community blank’ terms for RMNCH. There is an observed interchangeable use of terms and a lack of descriptions of these terms provided in the literature. There is a need for RMNCH researchers and practitioners to clarify the descriptions reported and improve the documentation of ‘community blank’ implementation. This can contribute to a better sharing of learning within and across communities and to bringing evidence-based practices to scale. Efforts to improve reporting can be supported with the use of standardised monitoring and evaluation processes and indicators. Therefore, it is recommended that future research endeavours clarify the operational definitions of ‘community blank’ and improve the documentation of its implementation.
- Health systems
- Maternal health
- Paediatrics
- Public Health
- Review
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
WHAT IS ALREADY KNOWN ON THIS TOPIC
While evidence suggests the effectiveness of approaches such as ‘community participation,’ ‘community engagement,’ ‘community mobilisation,’ ‘social accountability’ and ‘stakeholder engagement’ (collectively referred to as ‘community blank’) in improving reproductive, maternal, newborn and child health (RMNCH) outcomes, there is inconsistency in what these programmes entail when ‘community blank’ work is conducted.
WHAT THIS STUDY ADDS
This study demonstrates that while there is a large body of literature documenting ‘community blank’ in RMNCH, a relatively small portion of that literature provides detailed description of the activities, purposes and stakeholders involved.
These findings illustrate little to no pattern in when specific ‘community blank’ terms have been used and that terms are even used interchangeably or synonymously.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
This review helps to capture work that has been done globally since the Alma-Ata Declaration and calls for consistency and clarity in the way ‘community blank’ terms are reported.
As the majority of documents included in this review come from the scientific literature, it is recommended that the research community ensures the appropriate and intentional documentation of the procedures and processes relating to the implementation of ‘community blank.’
Improved documentation, supported by standardised monitoring and evaluation indicators, can inform the design and development of future ‘community blank’ work across settings.
Introduction
Health systems that work for and with the communities they serve are essential to achieving quality universal health coverage and the collective commitments agreed in the Sustainable Development Goals. The World Health Organization (WHO) has long recommended a policy framework for a ‘people-centred approach to health care, and a balanced consideration of rights and needs as well as responsibilities and capacities of all health constituents and stakeholders.’1 The Alma-Ata Declaration (1978), which emerged more than 40 years ago, promotes community participation as integral to health systems strengthening efforts.2 A number of reviews have concluded that there is evidence that involving communities in the co-production of health interventions or programmes is associated with improved health outcomes.3–10 Perhaps as a result, community-based interventions with components to engage or mobilise communities have been increasingly implemented for health systems strengthening including in research, emergency response and preparedness, as well as in reproductive, maternal, newborn and child health (RMNCH) programmes.8 11–17
Programmes that include the community as actors within an intervention rather than just a target audience have grown.18 19 Evidence describing these approaches draws on a range of different terminology such as ‘community engagement,’ ‘community mobilisation,’ ‘community participation,’ ‘community collaboration,’ ‘stakeholder engagement,’ ‘social mobilisation’ or ‘social accountability’ (hereafter, collectively but not exhaustively called ‘community blank’).17 These terms are often used interchangeably or in combination and appear to pertain to similar activities, or with little to no description of activities entailed or actions taken, leading to a lack of clarity that may reflect and/or cause confusion in both the research20–22 and programmatic16 23 settings. As these ‘community blank’ approaches are implemented with varying degrees of success,16 24–26 ensuring effective knowledge translation requires a common understanding of terminology. Programmes incorporating these approaches rely on good research and evaluation reporting to know how to implement them, highlighting the implications for research on ‘community blank’ and the importance of bridging the research-practice gap.
The purpose of this scoping review was to explore the literature to describe and catalogue the different ‘community blank’ terms and how they were reported and used in the RMNCH literature. The overall objective of this review is to answer the question: How is ‘community blank’ for RMNCH reported in the literature? This is divided into the following subquestions: (1) What are the different activities associated with ‘community blank’ for RMNCH? (2) What is the purpose of implementing ‘community blank’? (3) Who are the stakeholders (actors and beneficiaries) involved in ‘community blank’ activities?
Methods
A scoping review was conducted following the methodology described by Arksey and O’Malley and according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRSIMA-ScR) checklist (online supplemental appendix 1).27 28 The review protocol was prospectively published on the Open Science Framework (https://osf.io/d3cs7/).
Supplemental material
Search strategy
The search strategy, developed with expert advice from a librarian information specialist and provided in table 1, was designed around two concepts: terms related to ‘community blank’ and RMNCH terms, using the Boolean operator “OR” in between terms, and “AND” in between concepts. The ‘community blank’ search terminology was informed by search strategies used by previously published reviews of the literature in order to be as comprehensive as possible and capture any potentially relevant literature.20 29 30 The search was run in seven databases [PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Web of Science, and Global Health] on 20 May 2021 and updated on 01 October 2021. Online supplemental appendix 2 provides the detailed search strategy and resulting records across databases. OAIster and OpenGrey were searched for grey literature using a similar but adapted search strategy (online supplemental appendix 3). Fifteen organisation websites were also searched for reports of active community-related programming (online supplemental appendix 4 provides a full list of organisations). Additional snowballing techniques included examining reference lists of included studies as well as reference lists of 40 relevant, previous systematic and/or literature reviews (online supplemental appendix 5). Finally, an additional snowballing technique searching for the specific terms that appeared in papers after screening that were not included in original search results was conducted on PubMed (online supplemental appendix 6).
Search strategy
Eligibility criteria
All document types (peer review, grey literature, policy documents, reports) were included if they examined or described activities working with or involving communities in RMNCH programmes. Articles published on or after 1975 were included to capture the period just prior to the 1978 Alma-Ata Declaration and subsequent years. This scoping review excluded editorials, commentaries, or previous reviews and guidelines that solely included secondary data. It also excluded articles where ‘community blank’ was conducted for the purpose of promoting health research/trials (eg, ‘community engagement’ activities undertaken to improve recruitment for a vaccine trial) in part because there are a number of reviews focusing on this topic.5 20 31 32 While there was no exclusion based on language, searches were conducted in English. Online supplemental appendix 7 details the inclusion and exclusion criteria.
Study selection and management
Records from the search were imported into Covidence,33 an online information management system. After removing duplicates, two reviewers (SD, OC) independently screened articles by title and abstract. After discussing conflicts, reviewers independently screened articles by full text. A third reviewer (ADB/BG) reviewed and resolved any discrepancies in inclusion at both title/abstract and full text phases.
Data extraction
Two reviewers (SD, OC) extracted data from included documents on the Covidence platform and subsequently exported the data into Excel. Extracted data included: setting, project aim, RMNCH outcome, target population/participants, ‘community blank’ terms used, any formal definitions or frameworks about the ‘community blank’ term, the purpose of ‘community blank,’ the activities or components conducted/description of the programme, and the actors and beneficiaries (stakeholders) involved. The first several documents were double-extracted independently and checked for consistency before authors independently extracted remaining documents. In total, over 25% of documents were double-extracted to provide a quality check and confirm consistency in extraction among reviewers.
Data summarisation and visualisation
Documents were grouped and organised by reported terminology. Specific terms as reported by the documents were captured and grouped where appropriate (eg, ‘community mobilisation and sensitisation’ was included in the ‘community mobilisation’ category and ‘systematic community engagement’ was considered ‘community engagement’). Published documents referring to the same project were also grouped together. The extracted data were cleaned and sorted in Excel according to the review questions in order to describe and qualitatively summarise trends relating to the reported activities, purposes and stakeholders of ‘community blank.’ The data are reported in this review reflect the way authors reported them in the included documents. Tableau34 was used to visualise the data to illustrate patterns across when or where specific terminology was used and the activities associated with them. Basic descriptive statistics (eg, frequency of occurrence of various terms and activities across the included studies) were calculated and presented.
Findings
A total of 17 371 documents were identified (figure 1) through database searches. A further 257 documents were identified through other sources such as grey literature and reference lists. After removing duplicates, 9779 documents were screened by title and abstract and 534 were screened at full text. Reasons for exclusion (361 excluded documents) can be found in online supplemental appendix 8. In total, 173 documents are included in this review. Fifty publications35–84 refer to 15 individual projects (online supplemental appendix 9). Where there are examples from the same project, the number of projects is reported in addition to the number of publications. The completed data extraction sheet is included in online supplemental appendix 10. This review reports information from 161 peer-reviewed articles35–37 39–72 74–197 and 12 grey literature/reports.38 73 198–207
Flow diagram demonstrating study selection process. NGO, non-governmental organisation; PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses; RMNCH, reproductive, maternal, newborn and child health.
Description of included publications
The 173 included documents ranged in document type, study design (if applicable) and scope of implementation. Table 2 provides key summary characteristics of the included documents. The most common study designs were individually randomised and cluster-randomised control trials (n=36), qualitative studies using interviews or focus group discussions (n=31), mixed-methods studies (n=21), descriptive case studies (n=20), and cross-sectional studies (n=12). The earliest published document was from 1979 and over half (n=102) were published between 2017 and 2021. The 173 documents reported on projects in 51 countries across all six WHO regions. The most common WHO region was Africa (n=113) followed by South-East Asia (n=65), Americas (n=18), Western Pacific (n=16), Eastern Mediterranean (n=15) and Europe (n=3). Of the 173 publications, 169 document experiences in just 12 countries: India (n=27), Bangladesh (n=21), Malawi (n=18), Uganda (n=18), Pakistan (n=16), Zambia (n=13), Nepal (n=11), Ghana (n=10), Kenya (n=10), the USA (n=10), Nigeria (n=8) and Ethiopia (n=7).
Summary table
While a large number of terms were included in the search strategy to be as comprehensive as possible, 24 distinct ‘community blank’ terms were reported in the 173 documents for a total of 182 times (9 documents using more than 1 term) (online supplemental appendix 11). However, 17 terms were only used once, including 12 which included components of other terms. During the analysis, terms were synthesised into 11 categories. The most commonly used term was ‘community mobilisation’ (n=75, 51 projects), followed by ‘community engagement’ (n=49, 44 projects), ‘community participation’ (n=26, 26 projects), ‘social accountability’ (n=17, 14 projects), ‘social mobilisation’ (n=7, 7 projects), ‘community involvement’ (n=2, 2 projects) and ‘community empowerment’ (n=2, 2 projects). ‘Stakeholder engagement,’ ‘social engagement,’ ‘community outreach’ and ‘community collaboration’ were all used only once.
To further understand these ‘community blank’ terms, potential patterns and trends across time, region and RMNCH population groups were explored. As demonstrated by figure 2, terms were used relatively consistently across WHO regions. Notably, ‘community participation’ was the most common term in South-East Asia. Similarly, the distribution of terms over time can be seen in figure 3. While ‘community mobilisation’ was the most used term, there has been a decrease in its use in the most recent five years, coupled with an increased momentum in using the term ‘community engagement.’ The ‘community blank’ terms were used across all RMNCH population groups (online supplemental appendix 12). The prevalence of ‘social accountability’ in relation to reproductive health outcomes was greater than for other populations across RMNCH groups. For maternal health and newborn health, ‘community mobilisation’ has been the dominant term since 1990. Over time, the use of the ‘community blank’ terms for newborn health largely reflects those used for maternal health. Child health programmes most commonly used ‘community engagement,’ and this was consistently the more prevalent term used for child health focused activities in the preceding three decades.
‘Community Blank’ terms used across WHO regions.
‘Community Blank’ terms used over time.
Activities
‘Activities’ refer to the programming, actions or strategies that authors reported as contributing to or part of the ‘community blank’ that was conducted. Table 3 depicts the range of activities or components that were associated with ‘community blank’ terms and are reported as they were extracted from the papers (with some semantic alterations for clarity).
Activities, actions and components of work associated with ‘community blank’ in the literature and their descriptions
A total of 48 unique activities were revealed across the 173 included studies. For certain terms, specific activities were reported more often (figure 4). For example, reports of ‘community mobilisation’ most often referred to recurring group meetings and discussions (n=39; 27 of which are specifically labelled as ‘women’s groups’ in 10 unique projects), awareness/communication campaigns (n=22), community meetings (n=16), and village or community health committees (n=9). While recurring group meetings and discussions were mostly attributed to ‘community mobilisation’ (36 out of 49 total mentions), it is important to note that 17 of these publications were reporting on the implementation of the same intervention. ‘Community engagement’ activities focused on awareness/communication campaigns (n=9), health workers disseminating information (n=9), community dialogues (n=8), and meeting with communities (n=7) or other stakeholders (n=7) or local leaders for sensitisation (n=7). Similarly, ‘community participation’ included community meetings (n=6), awareness/communication campaigns (n=6), information sharing by health workers (n=4) and other community volunteers (n=4), community committees (n=4) and village or community health committees (n=4), and recurring group meetings (n=4). ‘Social accountability’ efforts demonstrated the most consistency, typically activities to develop and implement community scorecards or report cards (n=12), followed by community dialogues (n=4).
Activities used at least twice in community mobilisation, community engagement, community participation and social accountability.
In total, only 25 activities were mentioned more than twice in the literature and 19 of the 48 activities were attributed to at least three different ‘community blank’ terms. As demonstrated in table 3, only one activity was used with a distinct term more than twice (self-help groups as ‘community mobilisation,’ n=5, 4 projects). This demonstrates little to no trend evident in activities used for specific ‘community blank’ terms. The only exception is ‘social accountability,’ largely characterised by community score cards.
Purpose of community ‘blank’
Most papers attributed some purpose for the conduct of the community ‘blank.’ For those that did not explicitly state the purpose, one was composed by the review team based on the description of the programme. The purposes are classified into seven categories. Improving health outcomes, such as maternal and neonatal mortality and morbidity or preventing disease (n=73), and increasing care-seeking (n=62) were the dominant purposes described. Additional purposes include building knowledge (n=37), affecting health behaviours (n=23), improving the quality of care (n=16), and improving service delivery (n=11). Fifty publications described at least two purposes; for example, six of the ‘social accountability’ publications included multiple purposes. While improved health outcomes is the most common purpose across the four main terms (‘community mobilisation,’ ‘community engagement,’ ‘community participation’ and’ social accountability’), one notable difference is that ‘social accountability’ was also was the term most associated with improving quality of care (n=5) (online supplemental appendix 13).
On occasion, the purpose of ‘community blank’ was specific to programmatic outcomes. These programmatic outcomes were frequently cited for reproductive and child health. The main programmatic outcome noted for reproductive health was to increase family planning (n=11). For child health, the purposes were to increase care-seeking for pneumonia, malaria and diarrhoea (n=6), immunisation (n=6), injury prevention (n=2), disability care (n=1), and sickle cell care (n=1). For maternal and newborn health outcomes, purposes were specifically to improve nutrition (n=8) or the prevention of mother-to-child transmission of HIV (n=4).
Stakeholders
A range of stakeholders (the actors involved in ‘community blank’ activities as well as the targeted beneficiaries) were examined across publications. Multiple beneficiaries are noted in 97 publications. The primary beneficiaries were women (n=109), newborns (n=80), children (n=48), community members (n=12), men (n=6), households (n=1), adolescents (n=1), health workers (n=1) and service users (n=1). While newborns were the sole beneficiary in 16 papers, they were most often cited as a mother-newborn dyad (n=55), followed by mother-child dyad (n=15) or with other children (n=5). Women (n=39) and children (n=20) were also cited as sole beneficiaries across publications.
In relation to the actors noted, all but one publication described multiple actors involved in the activities, with 141 publications involving at least three actors. In total, there were 35 unique actors cited 665 times across the 173 publications and across the ‘community blank’ terms. Activities including just two actors were commonly health workers engaging directly with women or a facilitator leading a recurring group. Together, health workers (formal/trained) and volunteer health workers (unpaid, trained quickly to conduct similar tasks to formally trained health workers) were the most frequent actor. Figure 5 depicts the 22 different types of actors involved in the ‘community blank’ activities who were cited at least five times. This figure highlights that there is no discernible pattern between the type of actors involved and the ‘community blank’ terms. Any actor that was cited more than once was associated with at least two different ‘community blank’ terms, while 25 of the 35 unique of the actors were associated with at least three ‘community blank’ terms.
Actors involved in ‘community blank’ *Note: The numbers in this table may differ from those presented in the text due to the eight included studies that used more than one ‘community blank’ term. As a result, some actors have been counted twice. For example, if a study described their activities where women were an actor as ‘community mobilisation’ and ‘community engagement’ then this is counted in both terms for ‘women.’
Discussion
The findings of this review confirm an inconsistency and lack of clarity around the usage of ‘community blank’ terms and provide recommendations to address this gap (box 1).17 18 208 Across 173 publications, 24 distinct ‘community blank’ terms were used—however many of these were used in conjunction with other terms or were used interchangeably107 119 128 132 139 143 147 166 176 185 199—with four dominant terms: ‘community mobilisation,’ ‘community engagement,’ ‘community participation’ and ‘social accountability.’ If papers reported a specific definition of ‘community blank,’ these were captured in the data extraction and are reported in online supplemental appendix 10. The extent and depth of these definitions varied greatly, however the majority did not define how they conceptualised ‘community blank’ or provide a theoretical or formal definition of the term used. While 31 unique activities were reported more than once, 20 of these were associated with at least three distinct ‘community blank’ terms. Twelve of the 17 documents using the term ‘social accountability’ described community scorecards, whereas ‘community engagement’ and ‘community participation’ appear to be very similar (with 10 of their respective activities overlapping).
Recommendations
Clarify and determine consistent operational definitions for ‘community blank’ terms.
Develop and align to standardised monitoring and evaluation indicators.
Promote standardised reporting on the implementation of ‘community blank’ procedures and processes in the peer-reviewed and grey literature bases, including reporting the target audience, purpose, activities and the role of the community in the ‘community blank.’
The timeline of when ‘community blank’ terminology is used illustrates the presence of ‘community participation’ since 1975, with newer terms such as ‘community engagement’ and ‘social accountability’ joining the scene more recently in 2006 and 2011, respectively. Notably, the term ‘community mobilisation,’ which was the most used term in the included documents, has been consistently present since the 1990s. However, the literature on ‘community mobilisation’ referred to 10 unique projects and the final reports for these projects were published in 2017. Relatedly, the identified use of the term ‘community mobilisation,’ has since decreased in the past five years. This finding demonstrates the importance, and therefore the responsibility, of the research community in guiding the terms used.
Overall, there is a relatively small body of literature that describes what is being done when these ‘community blank’ terms are used. This is demonstrated by the fact that 123 articles were excluded at full-text phase (figure 1) because they provided no explanation of what was done, even though they included the terms of interest. Within the documents included in this review, the data are constrained by the limited level of detail in reporting the procedures and processes involved in implementing ‘community blank.’ There is a limited evidence base to describe the implementation of ‘community blank’ activities: the content, their purpose, the actors and stakeholders involved. Further research to understand the implementation of ‘community blank’ is important to address this knowledge-do gap.
Additionally, the literature base is limited by the dominance of 12 countries (Bangladesh, Ethiopia, India, Ghana, Kenya, Malawi, Nepal, Nigeria, Pakistan, Uganda, the USA, Zambia) which returned five or more publications. This dominance may be due to a lack (or a specific concentration) of funding, lack of activity, or lack of resources to document and report on activities and programming. Consequently, there is a narrow knowledge base of what is happening on a global scale. This gap in the evidence base contributes to the lack of clarity around ‘community blank’ terms, in particular the reporting on implementation. This has implications for the evaluation and translation of knowledge relating to ‘community blank’ across and within contexts.
Previous literature on ‘community blank’ or community interventions for health have put forward theoretical frameworks in attempts to clarify how these interventions are put into practice, including Arnstein’s eight-ring ‘ladder of citizen participation’ and Laverack’s nine domains of empowerment.17 209 210 Similar frameworks describe a range or spectrum of involvement, including the International Association for Public Participation’s five levels of inform, consult, involve, collaborate and empower.211 In the RMNCH field specifically, Gram, Desai and Prost put forward a matrix of the different styles and scopes of involving communities as: classrooms, clubs and collectives.212 Finally, a WHO guide on health promotion describes four levels of community engagement including approaches that are community-oriented, community-based, community-managed and community-owned.213 These various frameworks typically describe a spectrum of more to less involvement of the community, yet despite the availability of these frameworks, the findings of this review demonstrate a range of terms are used interchangeably. This may reflect an evolving nature of the ‘community blank’ terms and approaches, further demonstrated by the timeline of their usage. While some have argued that it is neither feasible nor useful to develop standardised definitions of ‘community blank,’ they have also acknowledged the importance of learning from the enabling actors, environments and roles in involving communities.18 214 These existing frameworks can provide an entry point for promoting conceptual clarity around ‘community blank,’ as well as an opportunity for cross-disciplinary learning.
In order to draw out these lessons, there is a need for conceptual clarity and specificity to enable the adequate documentation of implementation and ensure the translation of knowledge within and across settings.215 216 Failure to consistently describe ‘community blank’ interventions may also be a consequence of the ongoing lack of clarity in theory and inappropriate research methodologies. Growing calls for the research community to embed complexity and non-linearity in the research process from the beginning may contribute to more reliable documentation that can in turn enable the adaptation and replication of ‘community blank’ activities across contexts and countries.217 218 It is essential that RMCNH researchers and practitioners that engage in documenting and publishing on ‘community blank’ endeavours more adequately describe and share the content of the ‘community blank,’ its purposes, activities, actors and stakeholders involved. The majority of the evidence in this review comes from peer-reviewed literature; this means that the review reflects the language and experiences of the academic or research community, but it also highlights the potential role of the research community in facilitating dialogues and supporting conceptual clarity for ‘community blank’ terminology.
Additionally, the number of articles that were excluded in this review because they lacked such detail describing the ‘community blank’ points to this great need for clear and consistent documentation. This suggests a potential benefit of global standardised reporting and evaluation tools that can support a consistent use of ‘community blank’ terminology and better descriptions of the content of ‘community blank’ interventions. UNICEF’s ‘Minimum quality standards and indicators for community engagement’ began this effort by proposing 16 core standards each with a set of indicators with the purpose to establish a common language among all stakeholders for defining community engagement principles, key actions, goals and benchmarks.208 In order to standardise reporting of implementation of healthcare processes, defining the ‘construct of interest’ to provide clarity is generally considered the first step.219 In this way, clarity on when to use which ‘community blank’ terminology is warranted. These standardised indicators can include requirements for improved reporting on the content of ‘community blank,’ similar to global reporting standards such as the WHO Programme Reporting Standards for sexual, reproductive, maternal, newborn, child, and adolescent health.16 220 This could help to redress the current lack of detail available on aspects such as the target groups, purposes, activities and the role of community members in ‘community blank’ interventions. However, it is also important to consider who (ie, practitioners, researchers, donors, etc) would be responsible for ensuring these documentation and reporting standards are met.
Finally, there is a difference between working in and working with communities. Given the inconsistency and lack of clarity in reporting of ‘community blank,’ this review highlights the need for further investigation into the procedures and processes of ‘community blank’ efforts. It is recommended that future investigation should also include examining the direct level and extent of community members’ roles and responsibilities in these activities to better reflect the work being done.
Strengths and limitations
This review has several strengths and limitations. Most notably, the scope and range of papers included give a comprehensive and holistic look at literature in the RMNCH and ‘community blank’ space. The methodical and systematic search conducted enabled capture of a wide range of experiences as early as 1979, following the Alma-Ata Declaration. While this review did not exclude any studies based on language, the search was conducted primarily in English. This review used a specific search strategy based on the terms of interest, potentially limiting the number of returns. An additional limitation is that this review did not include publications that documented similar ‘community blank’ activities if they did not specifically use the terms of ‘community blank.’ This was due to the aim of the review being to determine what researchers and practitioners are doing when they say they are doing ‘community blank.’ As such, the papers included in this review do not represent the literature of all community activities, but rather just those that are ascribed as ‘community blank’ activities. A pivotal example of this is the seminal piece on the ‘Warmi methodology,’ which did not use any ‘community blank’ term but informed the recurring women’s groups across several studies.221 A similar challenge is demonstrated in the varying levels of detail used to describe the activities or actions associated with ‘community blank’ terms, notably the roles of the community and how they were or were not involved in these approaches. Conducting this review highlighted a limitation in the literature that many studies do not extensively report what they do when they use these ‘community blank’ terms, which required the reviewer team to make some judgements in synthesising and presenting the findings. This limitation of the overall literature base highlights the challenge of how knowledge is captured and shared and therefore how research agendas may contribute to advancing ‘community blank’ practice and policy. Relatedly, the review cannot capture what is not published or readily available. ‘Community blank’ is being used across the globe and being implemented by actors and/or programmes who have not written up and published their experiences in either the peer-reviewed literature or grey literature reports.
Conclusion
This scoping review highlights the lack of clarity and inconsistencies in how ‘community blank’ terms are used in the literature, impeding the ability to draw meaningful lessons for implementation. To advance ‘community blank’ for RMNCH, a more comprehensive reporting and documenting of ‘community blank’ implementation processes by researchers and all stakeholders is needed to improve clarity, to avoid confusion in practice, and to facilitate a better understanding of how these approaches work or do not work in a range of settings.16 23 The promotion of standardised reporting and monitoring and evaluation indicators that can capture the content of ‘community blank’ can support this effort. By clarifying our understanding of what we mean when we say we are doing ‘community blank’ and improving the documentation of ‘community blank’ practices, we can better share learning within and across communities to inform systematic changes and bring evidence-based practices to scale.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
Acknowledgments
The authors thank Diarmuid Stokes (UCD Library) for his advice and review of the database search strategy.
References
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
SD and OC are joint first authors.
Handling editor Stephanie M Topp
Twitter @dadasara3, @CocomanOlive, @anagportela, @aoife_db, @sanghitaami, @otuncalp, @brynne_gilmore
Contributors SD (guarantor) and OC (guarantor) are joint first authors. The protocol was developed by SD and OC, with input from BG and AP. SD and OC conducted the study screening and data extraction and drafted the manuscript. All authors reviewed and edited the manuscript prior to submission and approved it for publication.
Funding The publication fees for this review were supported by the World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing through a grant received from Merck Sharp and Dohme Corp (MSD).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.