Welcome!Community engagement in

public health interventions

for disadvantaged groups:

What's the evidence?

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What’s the evidence?

O’Mara-Eves A., Brunton G., Oliver S.,

Kavanagh J., Jamal F., & Thomas J. (2015).

The effectiveness of community engagement

in public health interventions for

disadvanted groups: A meta-analysis. BMC

Public Health, 15, 129.

http://healthevidence.org/view-

article.aspx?a=effectiveness-community-engagement-

public-health-interventions-disadvantaged-29020

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Alison O’Mara-Eves

Senior Research

Officer, University

College London,

Institute of Education,

EPPI-Centre

Ginny Brunton

Senior Health

Researcher, University

College London,

Institute of Education,

EPPI-Centre

Do public health interventions

that engage the community

improve health-related outcomes

for disadvantaged groups?

Systematic review and meta-analysis

Alison O’Mara-Eves and Ginny Brunton

EPPI-Centre

Social Science Research Unit

Department of Social Science

UCL Institute of Education

University College London

HealthEvidence.ca Webinar

21st October 2016

• This project was funded by the UK National

Institute for Health Research (NIHR). The views

and opinions expressed by authors in this

presentation are those of the authors and do not

necessarily reflect those of the NIHR.

• Project conducted by a team of researchers at

the UCL Institute of Education, London School of

Economics, and University of East London.

• All authors declared no conflicts of interest.

Funding and conflicts of interest

O'Mara-Eves A, Brunton G,

McDaid D, Oliver S,

Kavanagh J, Jamal F, et

al.

Community engagement

to reduce inequalities in

health: a systematic

review, meta-analysis and

economic analysis.

Public Health Research

2013;1(4).

The 548 page report

1. The research topic

What is community engagement?

• Community engagement defined here as a:

– direct or indirect process of involving communities in

decision-making and/or in the planning, design,

governance and delivery of services,

– using methods of consultation, collaboration, and/or

community control.

• Takes many forms. Examples:

service user networks healthcare forums

volunteering courses delivered by trained peers

interactive websites for views and opinions via surveys

public consultations

community coalitions

Health inequalities

• Socially determined differences in health

outcomes

• Causes are modifiable (e.g., socioeconomic

status, social exclusion) rather than biological

(e.g., genetic predisposition)

• Marmot Review of health inequalities in

England, ‘Fair Society, Healthy Lives’ (2010)

identified four key modifiable health risks:– Smoking

– Alcohol abuse

– Substance abuse

– Obesity

Health inequalities: priority areas

Marmot Review also identified six policy

objectives:

1. giving children the best start in life,

2. enabling all children, young people and adults to

maximise their capabilities,

3. creating fair employment and good work for all,

4. ensuring a healthy standard of living for all,

5. developing healthy and sustainable places and

communities, and

6. strengthening the role and impact of health

prevention.

Community engagement and health

inequalities

• Community engagement is arguably

particularly suited for disadvantaged and

socially excluded groups

• It is proposed that community engagement:

– encourages social justice and can “give a voice

to the voiceless”

– can produce interventions that better meet

community needs (cultural competence; more

empathic approaches)

2. The broader project

• Patchwork of theories and conceptual

frameworks

• Unclear empirical evidence about

effectiveness and cost-effectiveness

• Much uncertainty about processes

The research problem

Sensitive searches for systematic

reviews

Identified primary studies within

reviews

Extracted data on key concepts and

characteristics

Map of interventions

Selected interventions

targeting Marmot priority areas for in-

depth review

Extracted effectiveness data;

assessed risk of bias

Conducted syntheses

Overview of process

In-depth review syntheses

1. Effectiveness

2. Processes

3. Economic

4. Theoretical

Sensitive searches for systematic

reviews

Identified primary studies within

reviews

Extracted data on key concepts and

characteristics

Map of interventions

(n = 361)

Selected interventions

targeting Marmot priority areas for in-

depth review

Extracted effectiveness data;

assessed risk of bias

Results of:

Theory synthesis

Meta-analysis

Presentation coverage

3. Theory synthesis

Theory Synthesis Methods

• Many theories about why CE is important and

how it might work (or not!)

• We extracted data from included studies

– Key discussion pieces (‘background’ articles)

– Exemplar process evaluations

• We then grouped data and iteratively

developed themes

Discussion Pieces/Process Data Advisory Group Input

Conceptual Framework

Trials Data

Community Engagement in Interventions: Conceptual Framework

1. Empowerment: change is facilitated where the health

need is identified by the community and they mobilise

themselves into action

2. Collaboration or…

3. …consultation in intervention design: the views of

stakeholders are sought with the belief that the

intervention will be more appropriate to the

participants’ needs as a result

4. Lay-delivery: change is believed to be facilitated by

the credibility, expertise, or empathy that the

community member can bring to the delivery of the

intervention

Theories of change identified

in the theoretical synthesis

4. Meta-analysis

• Journal article: 23 pages

Results: Effectiveness studies (N = 131)

Countries– 4% (n = 5) UK

– 86% (n = 113) USA

– 4% (n = 5) Canada

– 6% (n = 8) other OECD

Population/Health inequalities– 43% (n = 56) ethnic minorities

– 26% (n = 34) low socioeconomic position

– 16% (n = 21) multiple health inequalities

Results: Health topic

0

2

4

6

8

10

12

14

16

18

18

1413 13

12

87

6 6 65 5

4 43

2 21 1 1

Health Topics (N=131 studies)

Results: Outcome types

• Health behaviours (n=105)

e.g. breastfeeding, attend

cancer screening

• Health consequences

(n=38)

e.g. mortality, diagnosis

• Participant self-efficacy

(n=20)

• Participant social support

(n=7)

• Also a small number of

community outcomes and

‘engagee’ outcomes – not

meta-analysed

Results: Overall mean effects

*** p < .001Statistical significance indicates the effect size estimate is significantly different from zero Note. 95% CI = 95% confidence intervaln = number of effect sizesτ2 = between studies variance

Heterogeneity

Outcome Pooled

effect size

estimate

95% C.I. n τ2 Q statistic I2

Health behaviours .33*** .26, .40 105 .093 604.62*** 82.80

Health consequences .16** .06, .27 38 .076 196.36*** 81.16

Participant self-efficacy .41** .16, .65 20 .278 480.44*** 96.05

Participant social

support

.44*** .23, .65 7 .067 42.67*** 85.94

In general, interventionsare effective

Variation amongst studies needs to be explained

• Conducted moderator and regression analyses

• Most of the analyses conducted on health

behaviour outcomes only because of small

number of data points

Attempts to explain variation

Moderator of effect on health

behaviours: Theory of change

Other moderators tested

• Single component interventions tended to be

more effective at improving health behaviours

than multiple component interventions

• Universal interventions tended to have higher

effect size estimates for health behaviour

outcomes than targeted interventions

• Interventions conducted in non-community settings

tended to be more effective than those in community

settings for health behaviour outcomes

Features of the interventions

• Interventions that employed skill development or training strategies,

or which offered contingent incentives, tended to be more effective

than those employing educational strategies for health behaviour

outcomes

• Interventions involving peers, community members, or education

professionals tended to be more effective than those involving health

professionals for health behaviour outcomes

• Shorter interventions tended to be more effective than longer

interventions for health behaviour outcomes; this is probably

confounded by levels of exposure or intensity of contact with the

intervention deliverer

Participant characteristics

• Interventions tended to

be most effective in

adult populations and

less effective in general

population interventions

for health behaviour

outcomes

• Interventions tended to

be most effective for

health behaviour

outcomes for

participants classified as

disadvantaged due to

socioeconomic position

5. Conclusions

Conclusions

• Overall, public health interventions using

community engagement strategies for

disadvantaged groups are effective in terms of

health behaviours, health consequences,

participant self-efficacy, and participant

perceived social support

• These findings appear to be not due to

systematic methodological biases

Conclusions

• However, there is still unexplained variation

amongst the effect sizes

• “…the evidence suggests that community

engagement in public health is more likely to

require a ‘fit for purpose’ rather than ‘one size

fits all’ approach.”

• Consult with communities to determine

whether and how they want to be engaged in

public health activities

• Co-authors:

– David McDaid

– Sandy Oliver

– Josephine Kavanagh

– Farah Jamal

– Tihana Matosevic

– Angela Harden

– James Thomas

• Authors of and participants in the reviewed

studies

Acknowledgements

EPPI-CentreDepartment of Social Science UCL Institute of EducationUniversity College London18 Woburn SquareLondon WC1H 0NR

Tel +44 (0)20 7612 6397Fax +44 (0)20 7612 6400Email eppi@ioe.ac.ukWeb eppi.ioe.ac.uk/

The final report is available to download at http://www.journalslibrary.nihr.ac.uk/phr/volume-1/issue-4

Further details a.o’mara-eves@ucl.ac.uk

A Model for Evidence-

Informed Decision Making

National Collaborating Centre for Methods and Tools. (revised 2012). A

Model for Evidence-Informed Decision-Making in Public Health (Fact

Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]

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