Barriers and facilitators of Patient-Public Engagement for health system improvement in Sub-Saharan Africa: A systematic scoping review

Ankomah, Samuel Egyakwa; Fusheini, Adam; Derrett, Sarah

doi:10.1016/j.hpopen.2021.100055

Cited by 4 publications

(6 citation statements)

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“…Effective delivery of SMC relies on community support and participation. There is increasing recognition of the importance of public engagement in planning all healthcare delivery [ 11 , 12 ]. SMC programmes have generally been welcomed by communities [ 6 , 13 – 19 ], but as SMC programmes are expanded there is a need for robust methods to listen to community perspectives and include them in the design of delivery strategies.…”

Section: Introductionmentioning

confidence: 99%

Facilitators and barriers to seasonal malaria chemoprevention (SMC) uptake in Nigeria: a qualitative approach

Ogbulafor¹,

Uhomoibhi²,

Shekarau³

et al. 2023

Malar J

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Background SMC was adopted in Nigeria in 2014 and by 2021 was being implemented in 18 states, over four months between June and October by 143000 community drug distributors (CDDs) to a target population of 23million children. Further expansion of SMC is planned, extending to 21 states with four or five monthly cycles. In view of this massive scale-up, the National Malaria Elimination Programme undertook qualitative research in five states shortly after the 2021 campaign to understand community attitudes to SMC so that these perspectives inform future planning of SMC delivery in Nigeria. Methods In 20 wards representing urban and rural areas with low and high SMC coverage in five states, focus group discussions were held with caregivers, and in-depth interviews conducted with community leaders and community drug distributors. Interviews were also held with local government area and State malaria focal persons and at national level with the NMEP coordinator, and representatives of partners working on SMC in Nigeria. Interviews were recorded and transcribed, those in local languages translated into English, and transcripts analysed using NVivo software. Results In total, 84 focus groups and 106 interviews were completed. Malaria was seen as a major health concern, SMC was widely accepted as a key preventive measure, and community drug distributors (CDDs) were generally trusted. Caregivers preferred SMC delivered door-to-door to the fixed-point approach, because it allowed them to continue daily tasks, and allowed time for the CDD to answer questions. Barriers to SMC uptake included perceived side-effects of SMC drugs, a lack of understanding of the purpose of SMC, mistrust and suspicions that medicines provided free may be unsafe or ineffective, and local shortages of drugs. Conclusions Recommendations from this study were shared with all community drug distributors and others involved in SMC campaigns during cascade training in 2022, including the need to strengthen communication about the safety and effectiveness of SMC, recruiting distributors from the local community, greater involvement of state and national level pharmacovigilance coordinators, and stricter adherence to the planned medicine allocations to avoid local shortages. The findings reinforce the importance of retaining door-to-door delivery of SMC.

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Section: Introductionmentioning

confidence: 99%

Facilitators and barriers to seasonal malaria chemoprevention (SMC) uptake in Nigeria: a qualitative approach

Ogbulafor¹,

Uhomoibhi²,

Shekarau³

et al. 2023

Malar J

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“…The literature reviewed consistently highlighted the importance of stakeholder collaboration–based on the shared values and vision–in developing the objectives and agenda for CE activities [ 21 , 25 , 39 , 80 , 81 ]. Among the most cited objectives for CE includes improving the level of general and specific PHC delivery, addressing healthcare access issues, particularly for disadvantaged people, and prevention and screening campaigns (e.g., HIV/AIDS, breast cancer screening) [ 21 , 24 , 25 , 36 , 38 , 44 ]. The need for a strategic policy direction to embed community participation as a core principle underpinning the development of PHC was one of the main lessons learnt in Ireland’s Joint Community Participation in Primary Care Initiative [ 82 ].…”

Section: Resultsmentioning

confidence: 99%

“…Convergent evidence from included studies suggests a common set of characteristics that underpin effective CE [ 21 – 25 , 36 – 38 , 40 , 44 , 81 ]. Key CE components that affected health outcomes included the wider socio-economic context, power dynamics and representation of communities and their voices, and cultural and organisational issues [ 12 , 21 – 25 , 36 , 37 , 40 , 51 ].…”

Section: Resultsmentioning

confidence: 99%

“…Conceptualising CE as a bounded, standardised ‘intervention’ can lead to framing the outcome measures only in terms of short-term attributes, while missing the bigger picture and multilevel effectiveness of CE. It is worth noting that only a few of the studies engaged communities in identifying and selecting appropriate outcomes and defining success for CE, including in studies where communities are given a role in shaping the development of the intervention programme itself [ 24 , 38 – 40 ]. In addition, the majority of the studies lacked (or loosely defined) the purpose of the evaluation about the information needs of various stakeholders.…”

Section: Discussionmentioning

confidence: 99%

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Community engagement initiatives in primary health care to achieve universal health coverage: A realist synthesis of scoping review

et al. 2023

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Background Community engagement (CE) is an essential component in a primary health care (PHC) and there have been growing calls for service providers to seek greater CE in the planning, design, delivery and evaluation of PHC services. This scoping review aimed to explore the underlying attributes, contexts and mechanisms in which community engagement initiatives contribute to improved PHC service delivery and the realisation of UHC. Methods PubMed, PsycINFO, CINAHL, Cochrane Library, EMBASE and Google Scholar were searched from the inception of each database until May 2022 for studies that described the structure, process, and outcomes of CE interventions implemented in PHC settings. We included qualitative and quantitative studies, process evaluations and systematic or scoping reviews. Data were extracted using a predefined extraction sheet, and the quality of reporting of included studies was assessed using the Mixed Methods Appraisal Tool. The Donabedian’s model for quality of healthcare was used to categorise attributes of CE into “structure”, “process” and “outcome”. Results Themes related to the structural aspects of CE initiatives included the methodological approaches (i.e., format and composition), levels of CE (i.e., extent, time, and timing of engagement) and the support processes and strategies (i.e., skills and capacity) that are put in place to enable both communities and service providers to undertake successful CE. Process aspects of CE initiatives discussed in the literature included: i) the role of the community in defining priorities and setting objectives for CE, ii) types and dynamics of the broad range of engagement approaches and activities, and iii) presence of an on-going communication and two-way information sharing. Key CE components and contextual factors that affected the impact of CE initiatives included the wider socio-economic context, power dynamics and representation of communities and their voices, and cultural and organisational issues. Conclusions Our review highlighted the potential role of CE initiatives in improving decision making process and improving overall health outcomes, and identified several organisational, cultural, political, and contextual factors that affect the success of CE initiatives in PHC settings. Awareness of and responding to the contextual factors will increase the chances of successful CE initiatives.

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“…Effective delivery of SMC relies on community support and participation. There is increasing recognition of the importance of public engagement in planning all healthcare delivery [10,11]. SMC programmes have generally been welcomed by communities [5; 12-18], but as SMC programmes are expanded there is a need for robust methods to listen to community perspectives and include them in the design of delivery strategies.…”

Section: Introductionmentioning

confidence: 99%

Facilitators and Barriers to SMC Uptake in Nigeria: A Qualitative Approach

Ogbulafor¹,

Uhomoibhi²,

Shekarau³

et al. 2022

Preprint

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Nigeria adopted Seasonal Malaria Chemoprevention (SMC) for children under 5 years of age as part of national malaria control policies, in 2014. By 2021 the intervention was being implemented in 18 states, delivered over 4 months between June and October by 143,000 community drug distributors (CDDs) to a target population of 23.1million children. Further expansion of SMC is planned, extending to 21 states in 2022 with a target population of 27.1 million children, and an increased number of monthly cycles, from 4 to 5, may be needed in some states. In view of this massive scale-up of SMC, the National Malaria Elimination Programme conducted a qualitative research study shortly after the 2021 campaign to understand community attitudes to SMC, and to identify barriers to uptake and facilitating factors, in order to ensure that community perspectives inform future planning of SMC delivery in Nigeria. In each of five states (Kano, Kwara, Nasarawa, Yobe and Kebbi), Local Government Areas (LGAs) were ranked based on administrative coverage of SMC in 2021, and one LGA with high coverage and one with low coverage selected. In two wards (one urban and one rural) in each LGA, focus group discussions (FGDs) were held with caregivers, and in-depth interviews (IDIs) were conducted with community leaders and with community drug distributors. State-level and LGA malaria focal persons were also interviewed. At national level, key-informant interviews (KIIs) were held with the NMEP coordinator, and representatives of partners working on SMC in Nigeria. Interviews were recorded and transcribed, and those in local languages translated into English, and the transcripts were analysed using NVivo software. A total of 190 FGDs, KIIs and IDIs were undertaken. In all study areas malaria was seen as a major health concern and SMC was widely accepted as a key preventive measure, and community drug distributors (CDDs) were generally trusted. Caregivers preferred SMC delivered door-to-door to the fixed-point approach, because in addition to allowing them to continue daily tasks, door-to-door delivery allowed more time for the CDD to explain how to administer the treatments and advise about adverse reactions and to answer questions. Barriers identified included perceived side effects of SMC drugs, a lack of understanding of the purpose of SMC, mistrust and suspicions that medicines provided free may be unsafe or ineffective. Key informants and caregivers reported SMC distributions limited by drug shortages, supplies running out before all children in the community had been treated. Key findings from this study were shared with delivery teams during national and state level training in 2022 and through cascade training to all community drug distributors and others involved in SMC campaigns. Other steps to act on the findings will include updating the training curriculum to show SMC teams how to strengthen communication to caregivers on the importance, safety and effectiveness of SMC, during campaigns; more involvement of state and national level pharmacovigilance coordinators during implementation to improve completion and submission of individual case safety reports and investigation of suspected adverse drug reactions. To avoid local shortages of SMC drugs, NMEP will ensure stricter adherence to the planned medicine allocations for each facility based on microplanning estimates. Study findings were shared with donors and implementing partners, to reinforce the importance of retaining primarily door-to-door delivery of SMC in Nigeria.

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Barriers and facilitators of Patient-Public Engagement for health system improvement in Sub-Saharan Africa: A systematic scoping review

Cited by 4 publications

References 43 publications

Facilitators and barriers to seasonal malaria chemoprevention (SMC) uptake in Nigeria: a qualitative approach

Facilitators and barriers to seasonal malaria chemoprevention (SMC) uptake in Nigeria: a qualitative approach

Community engagement initiatives in primary health care to achieve universal health coverage: A realist synthesis of scoping review

Facilitators and Barriers to SMC Uptake in Nigeria: A Qualitative Approach

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