1663. Community Engagement for Ebola Prevention in Eastern Democratic Republic of Congo

Abstract Background The second largest outbreak of Ebolavirus in history is currently ongoing in Eastern DRC. The epidemic is characterized by social resistance to foreign-led response teams. Trusted local health practitioners, including medical students, may be valuable social mobilizers in this challenging context. Methods We report on a student-led educational campaign to increase community awareness and engagement in EVD control efforts. We evaluated student and community participant satisfaction using standardized questionnaires. Results The outreach was conducted in November 2018, involving parades, speeches, branded banners and T-shirts, and interpersonal interactions in public spaces. Key messages, linked to previously identified resistant attitudes, included: “Ebola exists in Butembo,” “Bring infected family members to the Ebola Treatment Unit,” and “Leave burials to the official team.” Medical students (n = 355) and community participants (n = 319) evaluated the outreach campaign. Satisfaction was high: 320 (90%) students agreed that medical students could contribute to the EVD response effort, and 233 (73%) community members agreed that the students had helped them understand Ebola in the area. Lower satisfaction scores were associated with self-reported “resistant” attitudes (e.g., intention to hide infected family member from authorities, ρ = -0.25, P < 0.0001), denial of the existence of Ebola in the area (ρ = -0.17, P = 0.0018), and mistrust of the foreign response team (e.g., belief in mercenary motive, ρ = -0.11, P = 0.042). Higher satisfaction scores were associated with the view that local engagement was critical to ending the epidemic (ρ = +0.13, P = 0.017). Both students (77%) and community members (71%) agreed that they were more motivated to combat Ebola as a result of the outreach, suggesting that the activities fostered empowerment. Conclusion Medical students can lead satisfactory community engagement and educational activities during an EVD epidemic. As trusted local health agents, medical students may be valuable allies in building public trust and cooperation in this epidemic complicated by social resistance. Disclosures All authors: No reported disclosures.

Download Full-text

842. Social Resistance Fuels Ebola Transmission in the Eastern Democratic Republic of Congo

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.027 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S12-S12

Author(s):

Qaasim Mian ◽

Kasereka Masumbuko Claude ◽

Jack Underschultz ◽

Michael Hawkes

Keyword(s):

Focus Group ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

The Body ◽

Response Effort ◽

Republic Of Congo ◽

Community Resistance ◽

Social Resistance ◽

Health Authorities ◽

Media Reports

Abstract Background The second largest Ebola epidemic in history is currently raging in Eastern Democratic Republic of Congo (DRC). Stubbornly persistent Ebola transmission has been associated with social resistance, ranging from passive noncompliance to overt acts of aggression toward Ebola response teams. Methods We explored community resistance using focus group discussions and assessed the prevalence of resistant views using standardized questionnaires. Results Despite being generally cooperative and appreciative of the foreign-led Ebola response, focus group participants provided eyewitness accounts of aggressive resistance to control efforts, consistent with recent media reports. Mistrust of Ebola response teams was fueled by perceived inadequacies of the response effort (“herd medicine”), suspicion of mercenary motives, and violation of cultural burial mores (“makeshift plastic morgue”). Survey questionnaires found that the majority of respondents had compliant attitudes with respect to Ebola control. Nonetheless, 78/630 (12%) respondents believed that Ebola was fabricated and did not exist in the area, 482/630 (72%) were dissatisfied with or mistrustful of the Ebola response, 60/630 (9%) sympathized with perpetrators of overt hostility, and 102/630 (15%) expressed noncompliant intentions in the case of Ebola illness or death in a family member, including hiding from the health authorities, touching the body, or refusing an official burial team. Denial of the biomedical discourse and dissatisfaction/mistrust of the Ebola response were statistically significantly associated with indicators of social resistance. Conclusion We concluded that social resistance to Ebola control efforts was prevalent among focus group and survey participants. Mistrust, with deep political and historical roots in this area besieged by chronic violence and neglected by the outside world, may fuel social resistance. Resistant attitudes may be refractory to short-lived community engagement efforts targeting the epidemic but not the broader humanitarian crisis in Eastern DRC. Disclosures All Authors: No reported Disclosures.

Download Full-text

Preliminary results on the control of Aedes spp. in a remote Guatemalan community vulnerable to dengue, chikungunya and Zika virus: community participation and use of low-cost ecological ovillantas for mosquito control

F1000Research ◽

10.12688/f1000research.8461.3 ◽

2017 ◽

Vol 5 ◽

pp. 598 ◽

Cited By ~ 1

Author(s):

Gerard Ulibarri ◽

Angel Betanzos ◽

Mireya Betanzos ◽

Juan Jacobo Rojas

Keyword(s):

Community Engagement ◽

Vector Control ◽

Zika Virus ◽

Health Personnel ◽

Mosquito Control ◽

Health Workers ◽

Low Cost ◽

Local Health ◽

Community Members ◽

Integrated Intervention

Objective: To study the effectiveness of an integrated intervention of health worker training, a low-cost ecological mosquito ovitrap, and community engagement on Aedes spp. mosquito control over 10 months in 2015 in an urban remote community in Guatemala at risk of dengue, chikungunya and Zika virus transmission. Methods: We implemented a three-component integrated intervention consisting of: web-based training of local health personnel in vector control, cluster-randomized assignment of an ecological modified ovitrap (ovillantas: ovi=egg, llanta=tire) or standard ovitraps to capture Aedes spp. mosquito eggs (no efforts have been taken to determine the exact Aedes species at this moment), and community engagement to promote participation of community members and health personnel in the understanding and maintenance of ovitraps for mosquito control. The intervention was implemented in local collaboration with Guatemala’s Ministry of Health’s Vector Control Programme, and in international collaboration with the National Institute of Public Health in Mexico. Findings: Eighty percent of the 25 local health personnel enrolled in the training programme received accreditation of their improved knowledge of vector control. When ovillantas were used in a cluster of ovitraps (several in proximity), significantly more eggs were trapped by ecological ovillantas than standard ovitraps over the 10 month (42 week) study period (t=5.2577; p<0.05). Repetitive filtering and recycling of the attractant solution (or water) kept the ovillanta clean, free from algae growth. Among both community members and health workers, the levels of knowledge, interest, and participation in community mosquito control and trapping increased. Recommendations for enhancing and sustaining community mosquito control were identified. Conclusion: Our three-component integrated intervention proved beneficial to this remote community at risk of mosquito-borne diseases such as dengue, chikungunya, and Zika. The combination of training of health workers, cluster use of low-cost ecological ovillanta to destroy the second generation of mosquitoes, and community engagement ensured the project met local needs and fostered collaboration and participation of the community, which can help improve sustainability. The ovillanta intervention and methodology may be modified to target other species such as Culex, should it be established that such mosquitoes carry Zika virus in addition to Aedes.

Download Full-text

Preliminary results on the control of Aedes spp. in a remote Guatemalan community vulnerable to dengue, chikungunya and Zika virus: community participation and use of low-cost ecological ovillantas for mosquito control

F1000Research ◽

10.12688/f1000research.8461.2 ◽

2016 ◽

Vol 5 ◽

pp. 598 ◽

Cited By ~ 2

Author(s):

Gerard Ulibarri ◽

Angel Betanzos ◽

Mireya Betanzos ◽

Juan Jacobo Rojas

Keyword(s):

Community Engagement ◽

Vector Control ◽

Zika Virus ◽

Health Personnel ◽

Mosquito Control ◽

Health Workers ◽

Low Cost ◽

Local Health ◽

Community Members ◽

Integrated Intervention

Download Full-text

Working with community researchers to enhance rural community engagement around Private Water Supplies: an exploration of the benefits and challenges

Qualitative Research ◽

10.1177/1468794120978883 ◽

2020 ◽

pp. 146879412097888

Author(s):

Rachel Creaney ◽

Mags Currie ◽

Paul Teedon ◽

Karin Helwig

Keyword(s):

Rural Communities ◽

Community Engagement ◽

Rural Community ◽

Methodological Approach ◽

Good Practice ◽

Duty Of Care ◽

Community Members ◽

Water Supplies ◽

Employment Opportunities

This project employed community researchers as a means of improving community engagement around their Private Water Supplies (PWS) in rural Scotland. In this paper, we reflect on working with community researchers in terms of the benefits and challenges of the approach for future rural research that seeks to improve community engagement. The paper (1) critiques the involvement of community researchers for rural community engagement, drawing on the experiences in this project and (2) provides suggestions for good practice for working with community researchers in rural communities’ research. We offer some context in terms of the role of community members in research, the importance of PWS, our approach to community researchers, followed by the methodological approach and findings and our conclusions to highlight that community researchers can be beneficial for enhancing community engagement, employability, and social capital. Future community researcher approaches need to be fully funded to ensure core researchers can fulfil their duty of care, which should not stop when data collection is finished. Community researchers need to be supported in two main ways: as continuing faces of the project after the official project end date and to transfer their newly acquired skills to future employment opportunities.

Download Full-text

Bringing Older Adults to the Table: Opportunities for Consumer Engagement in Planning and Policy Making

Innovation in Aging ◽

10.1093/geroni/igaa057.337 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 102-102

Author(s):

Alice Prendergast ◽

Kristi Fuller

Keyword(s):

Data Collection ◽

Community Engagement ◽

Community Involvement ◽

Social Connectedness ◽

Planning Process ◽

The United States ◽

Lessons Learned ◽

Service Planning ◽

Community Members ◽

Design Data

Abstract Efforts to include community voice in health policy and service planning are gaining recognition and support in the United States. Findings suggest community involvement can contribute to a better understanding of systems and factors that impact health, and, subsequently, more effective and sustainable policy and program design. Additionally, engagement can increase community buy-in, and community members can gain a greater awareness of services; increased confidence navigating systems; feelings of social connectedness; and capacity to advocate around issues through participation. Despite these findings, the extent to which community members are engaged in planning and decision-making varies considerably. Researchers from Georgia State University conducted a review of state plans on aging using the Person-Centered Outcomes Research Initiative (PCORI) Engagement Principles and the Health Research & Educational Trust’s Community and Patient Engagement Spectrum as frameworks to assess evidence of community engagement. The frameworks recognize engagement throughout the planning process, including design, data collection and interpretation, and dissemination. The review revealed that few planning processes described significant engagement, but rather met the minimal requirements established by federal policy. Federal guidance on community-informed planning practices is sparse, as are resources to support states in adopting these processes. To address this gap, the research team drew on the frameworks and other promising practices to design two community engagement projects, both in partnership with Georgia’s Division of Aging Services. Methods for participant engagement, data collection, interpretation and application of results, and lessons learned through both projects will be discussed, as well as potential implications.

Download Full-text

Experiences of community members and researchers on community engagement in an Ecohealth project in South Africa and Zimbabwe

BMC Medical Ethics ◽

10.1186/s12910-017-0236-3 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Rosemary Musesengwa ◽

Moses J. Chimbari

Keyword(s):

South Africa ◽

Community Engagement ◽

Community Members

Download Full-text

Community-engaged medical education: helping to address child health and social inequality

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2021-322024 ◽

2021 ◽

pp. edpract-2021-322024

Author(s):

Ravi Parekh ◽

Arti Maini ◽

Bethany Golding ◽

Sonia Kumar

Keyword(s):

Medical Education ◽

Medical Students ◽

Child Health ◽

Social Inequality ◽

Case Studies ◽

Healthcare Professionals ◽

Authentic Learning ◽

Local Communities ◽

Local Health ◽

Symbiotic Relationship

Medical education has a key role in helping to address child health and social inequality. In this paper we describe the rationale for developing a community-engaged approach to education, whereby medical schools partner with local communities. This symbiotic relationship enables medical students to experience authentic learning through working with communities to address local health and social priorities. Case studies of how such approaches have been implemented are described, with key takeaway points for paediatric healthcare professionals wanting to develop community-engaged educational initiatives.

Download Full-text

Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol

BMJ Open ◽

10.1136/bmjopen-2020-045822 ◽

2021 ◽

Vol 11 (9) ◽

pp. e045822

Author(s):

Lynn V Monrouxe ◽

Peter Hockey ◽

Priya Khanna ◽

Christiane Klinner ◽

Lise Mogensen ◽

...

Keyword(s):

Medical Students ◽

Success Factors ◽

Realist Review ◽

Physician Assistants ◽

Realist Evaluation ◽

Health Practitioner ◽

Local Health ◽

Medical Council ◽

Programme Theory ◽

Quantitative Evidence

IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and analysisThe intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might ‘work’ to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.Ethics and disseminationEthics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.

Download Full-text

The effect of community dialogues and sensitization on patient reporting of adverse events in rural Uganda: uncontrolled before-after study

10.1101/402503 ◽

2018 ◽

Author(s):

Helen Byomire Ndagije ◽

Leonard Manirakiza ◽

Dan Kajungu ◽

Edward Galiwango ◽

Donna Kusemererwa ◽

...

Keyword(s):

Adverse Events ◽

Community Engagement ◽

Adverse Drug Events ◽

Health Workers ◽

Household Survey ◽

Rural Setting ◽

Health Issues ◽

Community Members ◽

Cross Sectional ◽

Before And After

AbstractBackgroundThe patients that experience adverse events are in the best position to report them, only if they were empowered to do so. Systematic community engagement and support to patients in a rural setting to monitor any potential harm from medicines should provide evidence for patient safety.MethodsThis paper describes an uncontrolled before and after study aimed at assessing the effect of a community engagement strategy, the Community Dialogues and Sensitization (CDS) intervention between January and April 2017, on the knowledge, attitude and practice of reporting adverse drug events by community members in the two eastern Ugandan districts. A representative cross-sectional baseline household survey was done prior to the intervention in September 2016 (n=1034) and the end-line survey (n=827) in July 2017.ResultsAfter implementation of the CDS intervention, there was an overall 20% (95% CI=16- 25) increase in awareness about adverse drug events in the community. The young people (15- 24 years) demonstrated a 41% (95% CI =31-52) increase and the un-educated showed a 50% (95% CI=37-63) increase in awareness about adverse drug events. The attitudes towards reporting increased overall by 5% in response to whether there was a need to report ADEs (95% CI =3-7). An overall 115% (95% CI =137-217) increase in the population that had ever experienced ADEs was also reported.ConclusionOur evaluation shows that the CDS intervention increases knowledge, improves attitudes by catalyzing discussions among community members and health workers on health issues and monitoring safety of medicines.

Download Full-text

Control of Aedes aegypti in a remote Guatemalan community vulnerable to dengue, chikungunya and Zika virus: Prospective evaluation of an integrated intervention of web-based health worker training in vector control, low-cost ecological ovillantas, and community engagement

F1000Research ◽

10.12688/f1000research.8461.1 ◽

2016 ◽

Vol 5 ◽

pp. 598

Author(s):

Gerard Ulibarri ◽

Angel Betanzos ◽

Mireya Betanzos ◽

Juan Jacobo Rojas

Keyword(s):

Community Engagement ◽

Vector Control ◽

Zika Virus ◽

Health Personnel ◽

Mosquito Control ◽

Health Workers ◽

Low Cost ◽

Local Health ◽

Worker Training ◽

Integrated Intervention

Objective: To study the effectiveness of an integrated intervention of health worker training, a low-cost ecological mosquito ovitrap, and community engagement on Aedes spp. mosquito control over 10 months in 2015 in an urban remote community in Guatemala at risk of dengue, chikungunya and Zika virus transmission. Methods: We implemented a three-component integrated intervention consisting of: web-based training of local health personnel in vector control, cluster-randomized assignment of ecological ovillantas or standard ovitraps to capture Aedes aegypti mosquito eggs, and community engagement to promote participation of community members and health personnel in the understanding and maintenance of ovitraps for mosquito control. The intervention was implemented in local collaboration with the Ministry of Health’s Vector Control Programme, and in international collaboration with the National Institute of Public Health in Mexico. Findings: Eighty percent of the 25 local health personnel enrolled in the training programme received accreditation of their improved knowledge of vector control. Significantly more eggs were trapped by ecological ovillantas than standard ovitraps over the 10 month (42 week) study period (t=5.2577; p<0.05). Among both community members and health workers, the levels of knowledge, interest, and participation in community mosquito control and trapping increased. Recommendations for enhancing and sustaining community mosquito control were identified. Conclusion: Our three-component integrated intervention proved beneficial to this remote community at risk of mosquito-borne diseases such as dengue, chikungunya, and Zika. The combination of training of health workers, low-cost ecological ovillanta to destroy the second generation of mosquitoes, and community engagement ensured the project met local needs and fostered collaboration and participation of the community, which can help improve sustainability. The ovillanta intervention and methodology may be modified to target other species such as Culex, should it be established that such mosquitoes carry Zika virus in addition to Aedes.

Download Full-text