The effectiveness of community engagement in public health interventions for disadvantaged groups: a meta-analysis

BMC Public Health

James Thomas²  Farah Jamal¹  Josephine Kavanagh²  Sandy Oliver²  Ginny Brunton²  Alison O’Mara-Eves² 

[1] Institute for Health and Human Development, University of East, London, UK;Social Science Research Unit, UCL Institute of Education, London, UK

关键词: Intervention;    Evaluation;    Public health;    Theoretical model;    Meta-regression;    Meta-analysis;    Systematic review;    Community development;    Community participation;    Community engagement;   

Others  :  1141295
DOI  :  10.1186/s12889-015-1352-y

 received in 2013-12-19, accepted in 2015-01-05,  发布年份 2015

【 摘 要 】

Background

Inequalities in health are acknowledged in many developed countries, whereby disadvantaged groups systematically suffer from worse health outcomes such as lower life expectancy than non-disadvantaged groups. Engaging members of disadvantaged communities in public health initiatives has been suggested as a way to reduce health inequities. This systematic review was conducted to evaluate the effectiveness of public health interventions that engage the community on a range of health outcomes across diverse health issues.

Methods

We searched the following sources for systematic reviews of public health interventions: Cochrane CDSR and CENTRAL, Campbell Library, DARE, NIHR HTA programme website, HTA database, and DoPHER. Through the identified reviews, we collated a database of primary studies that appeared to be relevant, and screened the full-text documents of those primary studies against our inclusion criteria. In parallel, we searched the NHS EED and TRoPHI databases for additional primary studies. For the purposes of these analyses, study design was limited to randomised and non-randomised controlled trials. Only interventions conducted in OECD countries and published since 1990 were included. We conducted a random effects meta-analysis of health behaviour, health consequences, self-efficacy, and social support outcomes, and a narrative summary of community outcomes. We tested a range of moderator variables, with a particular emphasis on the model of community engagement used as a potential moderator of intervention effectiveness.

Results

Of the 9,467 primary studies scanned, we identified 131 for inclusion in the meta-analysis. The overall effect size for health behaviour outcomes is d = .33 (95% CI .26, .40). The interventions were also effective in increasing health consequences (d = .16, 95% CI .06, .27); health behaviour self-efficacy (d = .41, 95% CI .16, .65) and perceived social support (d = .41, 95% CI .23, .65). Although the type of community engagement was not a significant moderator of effect, we identified some trends across studies.

Conclusions

There is solid evidence that community engagement interventions have a positive impact on a range of health outcomes across various conditions. There is insufficient evidence to determine whether one particular model of community engagement is more effective than any other.

【 授权许可】

   
2015 O'Mara-Eves et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Harden A, Oliver S: Who’s listening? Systematically reviewing for ethics and empowerment. In Using Research for Effective Health Promotion. Edited by Oliver S, Peersman G. Open University Press, Buckingham; 2001.
• [2]Department of Health: Commissioning and System Management - PPE. Real involvement: Working with people to improve health services. Department of Health, London; 2008.
• [3]Boote J, Telford R, Cooper C: Consumer involvement in health research: a review and research agenda. Health Policy 2002, 61(2):213-36.
• [4]Swainston K, Summerbell C: The effectiveness of community engagement approaches and methods for health promotion interventions. University of Teeside, Teeside; 2008.
• [5]Wilcox D: Community participation and empowerment: putting theory into practice. RRA Notes 1994, 21:78-82.
• [6]Wallerstein N, Duran B: Using community-based participatory research to address health disparities. Health Promot Pract 2006, 7(3):312-23.
• [7]Rifkin S, Lewando-Hundt G, Draper A: Participatory approaches in health promotion and health planning a literature review. Health Development Agency, London; 2000.
• [8]Marmot Review Team: Fair society, healthy lives: the Marmot Review. Strategic review of health inequalities in England post-2010. The Marmot Review. London; 2010
• [9]Popay J, Attree P, Hornby D, Milton B, Whitehead M, French B, et al.: Community Engagement in Initiatives Addressing the Wider Social Determinants of Health: A rapid review of evidence on impact, experience and process. In. University of Lancaster, Lancaster; 2007.
• [10]O'Mara-Eves A, Brunton G, McDaid D, Oliver S, Kavanagh J, Jamal F, Matosevic T, Harden A, Thomas J: Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Res 2013, 1(4):ᅟ. doi:10.3310/phr01040
• [11]Brenner B, Manice M: Community engagement in children's environmental health research. Mt Sinai J Med 2011, 78(1):85-97.
• [12]Kelly L: Empowering A Community: Standing up to “The Powers That Be”. J Hum Ecol 2003, 14(6):417-24.
• [13]Arnstein S: A ladder of citizen participation. J Am Inst Planners 1969, 35(4):216-24.
• [14]O'Mara-Eves A, Brunton G, McDaid D, Kavanagh JSO, Thomas J: Techniques for identifying cross-disciplinary and ‘hard-to-detect’ evidence for systematic review. Res Synth Meth 2014, 5(1):50-9.
• [15]Kavanagh J, Oliver S, Lorenc T, Caird J, Tucker H, Harden A, Greaves A, Thomas J, Oakley A: School-based cognitive-behavioural interventions: a systematic review of effects and inequalities. Health Sociol Rev 2009, 18:61-78.
• [16]Lipsey M, Wilson D: Practical Meta-Analysis Thousand Oaks. Sage Publications, CA; 2001.
• [17]Higgins J, Green S, (editors): Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration; 2009. Available from www.cochrane-handbook.org.
• [18]Chinn S: A simple method for converting an odds ratio to effects size for use in meta-analysis. Stat Med 2000, 19:3127-31.
• [19]Buller DB, Morrill C, Taren D, Aickin M, Sennott-Miller L, Buller MK, et al.: Randomized trial testing the effect of peer education at increasing fruit and vegetable intake. J Natl Cancer Inst 1999, 91(17):1491-500.
• [20]Department for Communities and Local Government: Neighbourhood management: An overview of the 2003 and 2006 Round 1 Pathfinder household surveys. Department of Communities and Local Government, Neighbourhood Renewal Unit, London; 2006.
• [21]Fried LP, Carlson MC, Freedman M, Frick KD, Glass TA, Hill J, et al.: A social model for health promotion for an aging population: initial evidence on the Experience Corps model. J Urban Health. 2004, 81:64-78.
• [22]Ernst Cara C, Grant Therese M, Streissguth Ann P, Sampson PD: Intervention with high-risk alcohol and drug-abusing mothers: II. Three-year findings from the Seattle model of paraprofessional advocacy. J Commun Psychol. 1999, 27(1):19-38.
• [23]Watkins E, Harlan C, Eng E, Gansky S, Gehan D, Larson K: Assessing the effectiveness of lay health advisors with migrant farmworkers. Family Commun Health 1994, 16(4):72-87.
• [24]Winkleby MA, Feighery E, Dunn M, Kole S, Ahn D, Killen JD: Effects of an advocacy intervention to reduce smoking among teenagers. Arch Pediatr Adolesc Med 2004, 158(3):269-75.
• [25]Meta-Analysis at 25 [http://www.gvglass.info/papers/meta25.html]
• [26]Berk R: Statistical inference and meta-analysis. J Exp Criminol 2007, 3(3):247-70.
• [27]Lipsey M: Unjustified inferences about meta-analysis. J Exp Criminol 2007, 3(3):271-9.