Promoting women’s and children’s health through community groups in low-income and middle-income countries: a mixed-methods systematic review of mechanisms, enablers and barriers

Abstract

IntroductionCommunity mobilisation through group activities has been used to improve women’s and children’s health in a range of low-income and middle-income contexts, but the mechanisms through which it works deserve greater consideration. We did a mixed-methods systematic review of mechanisms, enablers and barriers to the promotion of women’s and children’s health in community mobilisation interventions.MethodsWe searched for theoretical and empirical peer-reviewed articles between January 2000 and November 2018. First, we extracted and collated proposed mechanisms, enablers and barriers into categories. Second, we extracted and synthesised evidence for them using narrative synthesis. We assessed risk of bias with adapted Downs and Black and Critical Appraisal Skills Programme checklists. We assigned confidence grades to each proposed mechanism, enabler and barrier.Results78 articles met the inclusion criteria, of which 39 described interventions based on a participatory group education model, 19 described community-led structural interventions to promote sexual health in marginalised populations and 20 concerned other types of intervention or multiple interventions at once. We did not have high confidence in any mechanism, enabler or barrier. Two out of 15 proposed mechanisms and 10 out of 12 proposed enablers and barriers reached medium confidence. A few studies provided direct evidence relating proposed mechanisms, enablers or barriers to health behaviours or health outcomes. Only two studies presented mediation or interaction analysis for a proposed mechanism, enabler or barrier.ConclusionWe uncovered multiple proposed mechanisms, enablers and barriers to health promotion through community groups, but much work remains to provide a robust evidence base for proposed mechanisms, enablers and barriers.PROSPERO registration numberCRD42018093695.

A future for the world's children? A WHO–UNICEF–Lancet Commission

“…The empirical evidence on the role of community engage ment in improving health outcomes for children and families is compelling, although the concept is not yet fully theorised. 129,130 Definitions of community are based on people's sense of belonging together, and the idea of communitas-inspired fellowship-which refers to shared experience and togetherness strengthened by rites of passage. However, all communities have hurdles to belonging, and the management of rights and res pons ibilities is an ongoing project.…”

Exploring the impact of a community participatory intervention on women's capability: a qualitative study in Gulu Northern Uganda

“…Our findings suggest that knowledge and the approach to learning through discussion, reflection in groups, critical consciousness (realization of the ability to address mother and child's health issues), and support (social and financial) contributed to changing women's health capabilities. An emerging body of evidence describes similar mechanisms triggered by participatory women's group interventions, but more research is needed to clarify and unpack these pathways [ 6 , 7 , 11 ].…”

Building cooperative learning to address alcohol and other drug abuse in Mpumalanga, South Africa: a participatory action research process

“…Firstly, Arnstein's classic ladder on forms and extents of citizen participation [38]. Secondly, a recent review of community mobilisation processes (mechanisms, enablers, and barriers), in which mechanisms are defined in instrumental terms as intervening between delivery of activities and outcomes, with enablers and barriers defined as features of the environments (physical and social), including process design, that modify ability to produce outcomes [39]. Thirdly, we drew on international learning on building social participation in health systems reflecting empowerment perspectives [40].…”

“…Meanings, relationships, and contradictions within and between themes were noted [49]. The research team then framed the descriptive results with reference to practitioner frameworks of citizen participation [38], community mobilisation [39] and social participation in health systems [40].…”

“…Considering community mobilisation mechanisms [39], the process was designed to transfer power to those most directly affected to coproduce new knowledge for action with activities enabling group participation and deliberation. There were some individual acts of information sharing within the group, and suggestions of wider sharing in the community.…”