Systematic Review of Community Interventions – Essential Reading for All Applied Health Researchers – in Fact All Applied Researchers

Consider a non-governmental organisation (NGO) dedicated to improving welfare for those who live in African slums. How could the NGO proceed?

  1. Conduct a survey, find that sanitation is the most pressing problem across the majority of slums, and involve communities in the design and implementation of a system of latrines, pipes and treatment plants – a strategy shown to be effective in the literature.
  2. Consult with slum communities to find out their concerns and then co-design bespoke solutions according to local priorities – a sanitation system here; garbage removal system there; micro-finance elsewhere.
  3. Engage with local communities to increase their capacity and self-confidence. For example, by replicating the famous Detroit soup kitchen model.[1] Then let them be the architects of their own fate.

These are all very different, yet all go under the title “Community Interventions”. In a massive systematic review of controlled studies,[2] O’Mara-Eves et al. found that community interventions are effective compared to no community intervention, and many of the studies are of high quality. Hardly surprisingly, more sustained interventions are more effective than those of shorter duration. The take home message is that community activation is a good thing, notwithstanding a few situations where it may have an effect opposite to that intended.[3] As to which of the above three types is best, “no man knoweth it,” but one assumes that different modes suit different circumstances. For example, the CLAHRC WM Director would not recommend method three above, since slum residents generally do not have sufficient disposable wealth to be the architects of their own fate.

— Richard Lilford, CLAHRC WM Director

References:

  1. Fenton-Smith R. Can Soup Change the World? BBC News. 13 March 2015.
  2. O’Mara-Eves A, Brunton G, McDaid D, et al. Community Engagement to Reduce Inequalities in Health: A Systematic Review, Meta-analysis and Economic Analysis. Public Health Research No. 1.4. Southampton, UK: NIHR Journals Library, 2013.
  3. Lilford RJ. Adverse Effects of Well-Intentioned Interventions to Improve Outcomes in Adolescence. CLAHRC WM News Blog. Jan 15 2016.
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