Impact of community participation in primary health care: what is the evidence?
Jessamy Bath A B C and John Wakerman A B
+ Author Affiliations
- Author Affiliations
A Centre of Research Excellence in Rural and Remote Primary Health Care, PO Box 666, Bendigo, Vic. 3552, Australia.
B Centre for Remote Health, a joint centre of Flinders University and Charles Darwin University, Alice Springs, PO Box 4066, Alice Springs, NT 0871, Australia.
C Corresponding author. Email: jess.bath@gmail.com
Australian Journal of Primary Health 21(1) 2-8 https://doi.org/10.1071/PY12164
Submitted: 21 December 2012 Accepted: 13 September 2013 Published: 1 November 2013
Abstract
Community participation is a foundational principle of primary health care, with widely reputed benefits including improved health outcomes, equity, service access, relevance, acceptability, quality and responsiveness. Despite considerable rhetoric surrounding community participation, evidence of the tangible impact of community participation is unclear. A comprehensive literature review was conducted to locate and evaluate evidence of the impact of community participation in primary health care on health outcomes. The findings reveal a small but substantial body of evidence that community participation is associated with improved health outcomes. There is a limited body of evidence that community participation is associated with intermediate outcomes such as service access, utilisation, quality and responsiveness that ultimately contribute to health outcomes. Policy makers should strengthen policy and funding support for participatory mechanisms in primary health care, an important component of which is ongoing support for Aboriginal Community Controlled Health Services as exemplars of community participation in Australia. Primary health-care organisations and service providers are encouraged to consider participatory mechanisms where participation is an engaged and developmental process and people are actively involved in determining priorities and implementing solutions.
References
Australian Primary Health Care Research Institute (2010) About us. Available at http://aphcri.anu.edu.au/about-us [Verified 4 September 2012]Baum F (2008) ‘The new public health.’ (Oxford University Press: Melbourne)
Bhutta ZA, Memon ZA, Soofi S, Salat MS, Cousens S, Martines J (2008) Implementing community-based perinatal care: results from a pilot study in rural Pakistan. Bulletin of the World Health Organization 86, 452–459.
| Implementing community-based perinatal care: results from a pilot study in rural Pakistan.Crossref | GoogleScholarGoogle Scholar | 18568274PubMed |
Brady M, Byrne J, Henderson G (2003) ‘Which bloke would stand up for Yalata?’ The struggle of an Aboriginal community to control the availability of alcohol. Australian Aboriginal Studies 2003, 62–71.
Chandler M, Lalonde C (1998) Cultural continuity as a hedge against suicide in Canada’s First Nations. Transcultural Psychiatry 35, 191–219.
| Cultural continuity as a hedge against suicide in Canada’s First Nations.Crossref | GoogleScholarGoogle Scholar |
Chilaka MA (2005) Ascribing quantitative value to community participation: a case study of the Roll Back Malaria (RBM) initiative in five African countries. Public Health 119, 987–994.
| Ascribing quantitative value to community participation: a case study of the Roll Back Malaria (RBM) initiative in five African countries.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2MrjvF2isw%3D%3D&md5=007a95bba8dd9836ba6f62b0c12b29f0CAS | 16188287PubMed |
Coote A, Lenaghan J (1997) ‘Citizens’ Juries: Theories into Practice.’ (Institute for Public Policy Research: London)
Crawford MJ, Rutter D, Manley C, Weaver T, Bhui K, Fulop N, Tyrer P (2002) Systematic review of involving patients in the planning and development of health care. British Medical Journal 325, 1263–1265.
| Systematic review of involving patients in the planning and development of health care.Crossref | GoogleScholarGoogle Scholar | 12458240PubMed |
Draper AK, Hewitt G, Rifkin S (2010) Chasing the dragon: developing indicators for the assessment of community participation in health programmes. Social Science & Medicine 71, 1102–1109.
| Chasing the dragon: developing indicators for the assessment of community participation in health programmes.Crossref | GoogleScholarGoogle Scholar |
Eckermann A, Dowd T, Chong E, Nixon L, Gray R, Johnson S (Eds) (2010) ‘Binan Goonj: bridging cultures in Aboriginal Health.’ (Elsevier Australia: Sydney)
Espino F, Koops V, Manderson L (2004) ‘Community participation and tropical disease control in resource-poor settings. Social, Economic and Behavioural Research, Special topic no. 2.’ (UNICEF/UNDP/World Bank/WHO: Geneva)
Fitzpatrick J, Ako W (2007) Empowering the initiation of a prevention strategy to combat malaria in Papua New Guinea. Rural and Remote Health 7, 693
Goodrow B, Scherzer G, Florence J (2004) An application of multidisciplinary education to a campus–community partnership to reduce motor vehicle accidents. Education for Health 17, 152–162..
| An application of multidisciplinary education to a campus–community partnership to reduce motor vehicle accidents.Crossref | GoogleScholarGoogle Scholar | 15763758PubMed |
Greco M, Carter M, Powell R, Sweeney K, Joliffe J, Stead J (2006) Impact of patient involvement in general practice. Education for Primary Care 17, 486–496.
Hancock L, Sanson-Fisher R, Perkins J, McClintock A, Howley P, Gibberd R (2001) Effect of a community action program on adult quit smoking rates in rural Australian towns: the CART project. Preventive Medicine 32, 118–127..
| Effect of a community action program on adult quit smoking rates in rural Australian towns: the CART project.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3ht1yrug%3D%3D&md5=e40876aaf55c7e86c8a36f49bf9c5b37CAS | 11162337PubMed |
Jolley G, Lawless A, Hurley C (2008) Framework and tools for planning and evaluating community participation, collaborative partnerships and equity in health promotion. Health Promotion Journal of Australia 19, 152–157.
Kibria T, Rob U, Moshiur R, Alam MM (2011) Community involvement to increase utilization of maternal health services: Experiences from rural Bangladesh. In ‘Population Association of America Annual Meeting’. (Population Council: Washington, DC) Available at http://www.comminit.com/en/children/content/community-involvement-increase-utilization-maternal-health-services-experiences-rural-ba [Verified 15 November 2012]
Lavoie JG, Forget E, Prakash T, Dahl M, Martens P, O’Neil J (2010) Have investments in on-reserve health services and initiatives promoting community control improve First Nations’ health in Manitoba? Social Science & Medicine 71, 717–724.
| Have investments in on-reserve health services and initiatives promoting community control improve First Nations’ health in Manitoba?Crossref | GoogleScholarGoogle Scholar |
Manandhar DS, Osrin D, Shrestha BP, Mesko N, Morrison J, Tumbahangphe KM, Tamang S, Thapa S, Shrestha D, Thapa B, Shrestha JR, Wade A, Borghi J, Standing H, Manandhar M, Costello AM, Members of the MIRA Makwanpur trial team (2004) Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomised controlled trial. Lancet 364, 970–979..
| Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 15364188PubMed |
Murthy RK, Klugman B (2004) Service accountability and community participation in the context of health sector reforms in Asia: implications for sexual and reproductive health services. Health Policy and Planning 19, i78–i86.
| Service accountability and community participation in the context of health sector reforms in Asia: implications for sexual and reproductive health services.Crossref | GoogleScholarGoogle Scholar | 15452018PubMed |
Mutton B (2004) Community participation: a bottom up approach. Health Issues 81, 19–21.
Nikniaz A, Alizadeh M (2007) Community participation in environmental health: Eastern Azerbaijan Healthy Villages project. Eastern Mediterranean Health Journal 13, 186–192.
Nilsen ES, Myrhaug HT, Johansen M, Oliver S, Oxman A (2006) Methods of consumer involvement in developing healthcare policy and research, clinical practice guidelines and patient information material. Cochrane Database of Systematic Reviews CD004563
O’Meara P, Houge T (2003) Saving Helimed: the power of community action in country Victoria. In ‘7th National Rural Health conference’, 1–4 March 2003, Hobart. (National Rural Health Alliance: Canberra) Available at http://nrha.ruralhealth.org.au/ conferences/docs/7thNRHC/Papers/generalpapers/omeara_houge.pdf [Verified 25 July 2012]
O’Rourke K, Howard-Grabman L, Seoane G (1998) Impact of community organization of women on perinatal outcomes in rural Bolivia. Pan American Journal of Public Health 3, 9–14.
| Impact of community organization of women on perinatal outcomes in rural Bolivia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c7msVOjug%3D%3D&md5=2642bab77479d8fb8048144a9f64ba64CAS | 9503957PubMed |
Oba N, McCaffrey R, Choonhapran P, Chutug P, Rueangram S (2011) Development of a community participation program for diabetes mellitus prevention in a primary care unit, Thailand. Nursing & Health Sciences 13, 352–359.
Oxford Centre for Evidence-Based Medicine (2009) ‘Levels of evidence.’ (University of Oxford: Oxford) Avaliable at http://www.cebm.net/?o=1025 [Verified 26 April 2013]
Perry H, Freeman P, Gupta S, Rassekh BM (2009) ‘How effective is community-based primary health care in improving the health of children?’ (Community-Based Primary Health Care Working Group, International Health Section, American Public Health Association)
Petticrew M, Roberts H (2003) Evidence, hierarchies, and typologies: horses for courses. Journal of Epidemiology and Community Health 57, 527–529.
Pickard S (1998) Citizenship and consumerism in health care: a critique of citizens’ juries. Social Policy and Administration 32, 226–244.
| Citizenship and consumerism in health care: a critique of citizens’ juries.Crossref | GoogleScholarGoogle Scholar |
Preston R, Waugh H, Larkins S, Taylor J (2010) Community participation in rural primary health care: Intervention or approach? Australian Journal of Primary Health 16, 4–16.
| Community participation in rural primary health care: Intervention or approach?Crossref | GoogleScholarGoogle Scholar | 21133292PubMed |
Raymond JS, Patrick W (1988) Empowerment for primary health care and child survival: escalating community participation, community competence, and self-reliance in the Pacific. Asia-Pacific Journal of Public Health 2, 90–95.
| Empowerment for primary health care and child survival: escalating community participation, community competence, and self-reliance in the Pacific.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1c3ltFyktw%3D%3D&md5=8353043ebc570a3448e4d1be3aa51f8fCAS | 3382562PubMed |
Rifkin SB (1990) ‘Community participation in maternal and child health/family planning programmes: an analysis based on case study materials.’ (World Health Organization: Geneva)
Rifkin SB (2009) Lessons from community participation in health programmes: a review of the post Alma-Ata experience. International Health 1, 31–36.
| Lessons from community participation in health programmes: a review of the post Alma-Ata experience.Crossref | GoogleScholarGoogle Scholar | 24036293PubMed |
Rosato M, Laverack G, Howard Grabman L, Tripathy P, Nair N, Mwansambo C, Azad K, Morrison J, Bhutta Z, Perry H, Rifkin S, Costello A (2008) Alma-Ata: rebirth and revision 5. Community participation: lessons for maternal, newborn, and child health. Lancet 372, 962–971..
| Alma-Ata: rebirth and revision 5. Community participation: lessons for maternal, newborn, and child health.Crossref | GoogleScholarGoogle Scholar | 18790319PubMed |
Rowley KG, Daniel M, Skinner K, Skinner M, White GA, O’Dea K (2000) Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian Aboriginal community. Australian and New Zealand Journal of Public Health 24, 136–144.
| Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian Aboriginal community.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3ltFGhug%3D%3D&md5=ebb45e120453d4be2bf52f88f22d03e3CAS | 10790932PubMed |
Rowley KG, O’Dea K, Anderson I, McDermott R, Saraswati K, Tilmoth R, Roberts I, Fitz J, Wang Z, Jenkins A, Best JD, Wang Z, Brown A (2008) Lower than expected morbidity and mortality for an Australian Aboriginal population: 10-year follow-up in a decentralised community. The Medical Journal of Australia 188, 283–287.
Rychetnik L, Frommer M, Hawe P, Shiell A (2002) Criteria for evaluating evidence on public health interventions. Journal of Epidemiology and Community Health 56, 119–127.
Sare D, Kirby D (1999) Road trauma reduction and injury prevention participation in rural communities. In ‘5th National Rural Health Conference’, 15–17 March 1999, Adelaide. (National Rural Health Alliance: Canberra) Available at http://nrha.ruralhealth.org.au/ conferences/docs/PAPERS/5_roadt.pdf [Verified 15 November 2012]
Tyrrell M, Grundy J, Lynch P, Wakerman J (2003) Laramba Diabetes Project: an evaluation of a participatory project in a remote Northern Territory community. Health Promotion Journal of Australia 14, 48–53.
Uddin MJ, Ashraf A, Sirajuddin AKM, Alam M, Tunon C (2001) ‘Incorporation of community’s voice into health and population sector programme of Bangladesh for its transparency and accountability.’ (ICDDR, B Centre for Health and Population Research: Dhaka)
Wakerman J, Humphreys J (2011) Sustainable primary health care services in rural and remote areas: Innovation and evidence. The Australian Journal of Rural Health 19, 118–124.
| Sustainable primary health care services in rural and remote areas: Innovation and evidence.Crossref | GoogleScholarGoogle Scholar | 21605224PubMed |
Wakerman J, Humphreys JS, Wells R, Kuipers P, Entwistle P, Jones J (2008) Primary health care delivery models in rural and remote Australia: a systematic review. BMC Health Services Research 8, 276
Warchivker I, Hayter A (2001) An evaluation of a nutrition program in a remote community in central Australia. In ‘6th National Rural Health Conference’, 4–7 March 2001, Canberra. (National Rural Health Alliance: Canberra) Available at http://nrha.ruralhealth. org.au/conferences/docs/papers/6_A_1_3.pdf [Verified 20 July 2012]
Wilson M, Bennett N, Grosvenor J, Jones T (2001) Local health planning to meet the needs of communities. In ‘6th National Rural Health Conference’, 4–7 March 2001, Canberra. (National Rural Health Alliance: Canberra) Available at http://nrha.ruralhealth.org.au [Verified 20 July 2012]
World Health Organization (1978) Declaration of Alma-Ata. International Conference on Primary Health Care, 6–12 September 1978, Alma-Ata, USSR.
World Health Organization (2002) ‘Community participation in local health and sustainable development: approaches and techniques.’ (World Health Organization: Geneva)
Zakus JDL (1998) Resource dependency and community participation in primary health care. Social Science & Medicine 46, 475–494.
| Resource dependency and community participation in primary health care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c7it1Wlsg%3D%3D&md5=3da835a8ce72322e079d3d8a0a90407aCAS |
