Community engagement in health systems interventions and research in conflict-affected countries: a scoping review of approaches

Figures & data

Table 1. Study definitions.

Community engagement	A dynamic relational process that facilitates communication, interaction, involvement, and exchange between an organization and a community for a range of social and organisational outcomes [13]
Co-creation	The process by which people collaboratively both define and implement a solution (i.e. co-design plus co-production) [14]
Co-design	Involves an attempt to define a problem and then define a solution, in an equal partnership of individuals who work within the system (e.g. healthcare staff), individuals with lived experience of using the system (e.g. service-users/carers) and ‘designers’ [14]
Co-production	Involves an attempt to implement a proposed solution in an equal partnership of individuals working within the system (e.g. healthcare staff), individuals with lived experience using the system (e.g. service-users/carers) and ‘designers’ (e.g. researchers/consultants) [14]
Conflict-affected country	Has produced more than 1,000 battle-related deaths over a ten-year period, or more than 200 battle-related deaths in any three-year period, as measured by the Uppsala Conflict Data Program [15]
Health system	Consists of all organisations, people, and actions whose primary intent is to promote, restore or maintain health, including efforts to influence determinants of health as well as more direct health-improving activities [16]
Participatory research	A broad term referring to research conducted ‘with and by’ participants rather than on them [17], participation can in reality include anything from involvement to collaborative action

Table 2. Search syntax and keywords for Medline.

Keywords	Medline
Conflict-affected situations	(1) ‘warfare and armed conflicts’/ or exp armed conflicts/ (2) Conflict* adj3 (affected or zone or zones or Armed or Political or Violent)).mp. (3) (War or Wars or Warfare or Rebel* or revolution* or Uprising* or Insurgen* or Complex emergenc*).mp. (4) (Political instability or Political unrest).mp. (5) 1 or 2 or 3 or 4
Health system	(6) ‘Delivery of Health Care’/ (7) Public Health Systems Research/ (8) (system* adj3 (care* or health* or healthcare*)).mp. (9) 6 or 7 or 8
Community engagement	(10) Community Participation/ or Community-Based Participatory Research/ (11) (Community* adj3 (action* or involve* or participat* or engag* or driven* or based)).mp. (12) (Public* adj3 (action* or involve* or participat* or engag* or driven* or based)).mp. (13) 10 or 11 or 12 (14) 5 and 9 and 13 (15) 5 and 9 and 14

Table 3. Eligibility criteria.

Criteria	Inclusion	Exclusion
1. Context	Includes a conflict-affected setting (e.g. peri-conflict, ‘post-conflict’).	Context is not a conflict-affected country, territory, or subnational setting.
2. Topic	Involves a national or subnational health system or health system component (e.g. governance, financing, workforce, medical products, information, service delivery).	Does not relate to a national or subnational health system or its components or anything about community engagement, participation, or co-design.
3. Outcomes	Describes community engagement, co-design, participatory approach or method/s or results.	Does not describe any community engagement approach, methods or results.
4. Source type	Includes primary research findings (e.g. qualitative, quantitative, mixed, case study).	Does not include primary research (e.g. opinion commentary, history, literature review, secondary analysis only).
5. Time-period	Published 2000+ and data were collected in 2000 or later.	Publication date or data collected before 2000.
6. Language	Any if an English abstract is available.	No English abstract.

Figure 1. PRISMA flow diagram for scoping reviews.

Figure 2. Documents by publications year.

Table 4. Sources and topics covered, ordered by lead author.

Lead author (year)	Reference	Country/ies	Participation	Co-design	Other
Abdullahi (2020) [18]	13	Nigeria	X
Adams (2020) [19]	15	Sierra Leone	X
Ager (2015) [20]	17	Nigeria	X	X
Akseer (2019) [21]	23	Afghanistan			X
Anwari (2015)[22]	14	Afghanistan	X
Baingana (2011)[23]	26	Uganda			X
Elmusharaf (2017) [24]	18	South Sudan	X
Erismann (2019) [25]	16	South Sudan, Haiti	X	X
Foster (2017) [26]	20	Myanmar, Thailand	X
Ho (2015) [27]	21	DRC	X
Kozuki (2018) [28]	27	South Sudan			X
Mandal (2005) [29]	19	South Sudan	X
Rosenberg (2017) [30]	31	Liberia			X
Sami (2018) [31]	30	South Sudan			X
Saymah (2015) [32]	28	Palestine			X
Sengupta (2020) [33]	22	India		X
Steven (2019) [34]	25	DRC			X
Tangseefa (2018) [35]	24	Myanmar			X
Valadez (2020) [36]	29	South Sudan			X

Johnston K, Taylor M. Engagement as communication: pathways, possibilities, and future directions. In: Johnston K, Taylor M, editors. The handbook of communication engagement. London UK: Wiley; 2018. p. 1–15.

 Google Scholar

Brandsen T, Honingh M. Definitions of co-production and co-creation. In: Brandsen T, Steen T, Verschuere B, editors. Co-production and co-creation: engaging citizens in public services. New York NY: Routledge; 2018. p. 9–17.

 Google Scholar

Strand H, Dahl M. Defining conflict-affected countries, background paper prepared for the education for all global monitoring report. Paris France: UNESCO; 2011.

 Google Scholar

World Health Organization. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva (Switzerland): World Health Organization; 2007.

 Google Scholar

Cornwall A, Jewkes R. What is participatory research? Soc Sci Med. 1995;41:1667–1676.

 PubMed Web of Science ®Google Scholar

Abdullahi SA, Smelyanskaya M, John S, et al. Providing TB and HIV outreach services to internally displaced populations in Northeast Nigeria: results of a controlled intervention study. PLoS Med. 2020;17:e1003218.

 PubMed Web of Science ®Google Scholar

Adams B, Vallières F, Duncan JA, et al. Stakeholder perspectives of community mental health forums: a qualitative study in Sierra Leone. Int J Ment Health Syst. 2020;14:50.

 PubMed Web of Science ®Google Scholar

Ager AK, Lembani M, Mohammed A, et al. Health service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: a systems dynamics analysis using group model building. Confl Health. 2015;9:30.

 PubMed Web of Science ®Google Scholar

Akseer N, Rizvi A, Bhatti Z, et al. Association of exposure to civil conflict with maternal resilience and maternal and child health and health system performance in Afghanistan. JAMA Network Open. 2019;2:e1914819–e1914819.

 PubMed Web of Science ®Google Scholar

Anwari Z, Shukla M, Maseed BA, et al. Implementing people-centred health systems governance in 3 provinces and 11 districts of Afghanistan: a case study. Confl Health. 2015;9:2.

 PubMed Web of Science ®Google Scholar

Baingana F, Mangen PO. Scaling up of mental health and trauma support among war affected communities in northern Uganda: lessons learned. Intervention. 2011;9:291–303.

 Google Scholar

Elmusharaf K, Byrne E, AbuAgla A, et al. Patterns and determinants of pathways to reach comprehensive emergency obstetric and neonatal care (CEmONC) in South Sudan: qualitative diagrammatic pathway analysis. BMC Pregnancy Childbirth. 2017;17:278.

 PubMed Web of Science ®Google Scholar

Erismann S, Gürler S, Wieland V, et al. Addressing fragility through community-based health programmes: insights from two qualitative case study evaluations in South Sudan and Haiti. Health Res Policy Syst. 2019;17:20.

 PubMed Web of Science ®Google Scholar

Foster AM, Arnott G, Hobstetter M. Community-based distribution of misoprostol for early abortion: evaluation of a program along the Thailand-Burma border. Contraception. 2017;96:242–247.

 PubMed Web of Science ®Google Scholar

Ho LS, Labrecque G, Batonon I, et al. Effects of a community scorecard on improving the local health system in Eastern Democratic Republic Of Congo: qualitative evidence using the most significant change technique. Confl Health. 2015;9:27.

 PubMed Web of Science ®Google Scholar

Kozuki N, Ericson K, Marron B, et al. The resilience of integrated community case management in acute emergency: a case study from Unity State, South Sudan. J Glob Health. 2018;8:020602.

 PubMed Web of Science ®Google Scholar

Mandal M, Purdin S, McGinn T. A study of health facilities: implications for reproductive health and HIV/AIDS programs in southern Sudan. Int Q Community Health Educ. 2005;24:175–190.

 PubMedGoogle Scholar

Rosenberg E. Motivating factors contributing to retention of community health workers in rural liberia: a qualitative study. Ann Glob Health. 2017;83:135–136.

 Google Scholar

Sami S, Amsalu R, Dimiti A, et al. Understanding health systems to improve community and facility level newborn care among displaced populations in South Sudan: a mixed methods case study. BMC Pregnancy Childbirth. 2018;18:325.

 PubMed Web of Science ®Google Scholar

Saymah D, Tait L, Michail M. An overview of the mental health system in Gaza: an assessment using the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS). Int J Ment Health Syst. 2015;9:4.

 PubMed Web of Science ®Google Scholar

Sengupta A, Sahoo M, Khan A, et al. Maternal health status in tribal India: a 5-Year intervention program and its outcome. Indian J Community Med. 2020;45:189–193.

 PubMed Web of Science ®Google Scholar

Steven VJ, Deitch J, Dumas EF, et al. “Provide care for everyone please”: engaging community leaders as sexual and reproductive health advocates in North and South Kivu, Democratic Republic Of The Congo. Reprod Health. 2019;16:98.

 PubMed Web of Science ®Google Scholar

Tangseefa D, Monthathip K, Tuenpakdee N, et al. “Nine Dimensions”: a multidisciplinary approach for community engagement in a complex postwar border region as part of the targeted malaria elimination in Karen/Kayin State, Myanmar. Wellcome Open Res. 2018;3:116.

 PubMedGoogle Scholar

Valadez JJ, Berendes S, Odhiambo J, et al. Is development aid to strengthen health systems during protracted conflict a useful investment? The case of South Sudan, 2011–2015. BMJ Glob Health. 2020;5:e002093.

 PubMed Web of Science ®Google Scholar