GCRF_NF225 - Improving community engagement with COVID-19 public health messages in hard to reach communities
Lead Research Organisation:
University of Central Lancashire
Department Name: Sch of Comm Health & Midwifery
Abstract
Pakistan has one of the highest number of confirmed coronavirus cases in the world, with potentially devastating health and economic implications for a population heavily dependent on daily incomes. It is important to ensure that communities understand and act on public health messages to limit the spread of further coronavirus outbreaks. This may be difficult to achieve in hard to reach populations, particularly when such messages are not sensitive to their culture. Previous health crises have highlighted that mistrust and rumour can under-mine public confidence in the scientific evidence and can be a dangerous hindrance to response efforts. Our study will explore the cultural barriers and facilitators to communicating public health and safety guidance in rural communities in North West Pakistan. We will focus on an impoverished brick-kiln community near Peshawar, where households have average income of less than one US dollar a day, many have limited access to clean water and unequal access to education and healthcare. We will work with the community to develop a response that is both effective and consistent with local interests. As well as finding out about best ways to engage the community to follow public health advice, the community will decide on the material resources needed to support and implement these guidelines, such as providing a clean water supply. Researchers will work with community members to produce a toolkit that will help to support communication, community engagement and risk minimisation in similar hard to reach communities for future health crises.
Publications
Moran V
(2023)
Participatory action research to co-design a culturally appropriate COVID-19 risk communication and community engagement strategy in rural Pakistan
in Frontiers in Public Health
| Description | We are continuing to analyse our data but early indications are that our participatory approach to RCCE, along with democratised resource mobilisation, has lead to sustainable improvements in the remote rural community in which we conducted our research. 'Covid safety' kits, comprising masks, soap, sanitisers, have been widely distributed, six wells have been provided with solar power and three water coolers installed in the community. There are some interesting emergent resonances between the implicit democracy of participatory action research and local cultural forms, such as community Jirga, which we will explore in our analysis of qualitative data. The role of the community health champions (CHCs) have been crucial to facilitating community engagement and dissemination processes in the project. These lay health champions had a key role in connecting and communicating the deliberations of the PAR groups back into the wider community and vice versa; operating as a two-way vector for information exchange. Making the established school and adjacent health centre a key locus within the study consolidated community appreciation of general and specific aspects of public health knowledge and practice. Early indications are that the trust placed in these community assets, reinforced by further mobilisation of supportive resources, have proved to be a springboard for establishing trust and meaningful participation in this project. We hope that the grounding of such developments in local culture and values will deliver a legacy that offers a foundation for future public health initiatives and emergency responses. |
| Exploitation Route | The outcomes will be of use to government and NGOs involved in RCCE. |
| Sectors | Healthcare,Government, Democracy and Justice |
| Description | At the time of funding, Pakistan had one of the highest number of confirmed coronavirus cases in the world, with devastating health and economic implications for a population heavily dependent on daily incomes. We have worked with a remote rural community in Pakistan to develop a risk communication and community engagement (RCCE) strategy that is both effective and consistent with local interests. As well as finding out about best ways to engage the community to follow public health advice, a key component of the work rested on community-led decision making about the mobilisation of material resources needed to support and implement these guidelines. Facilitated by a participatory action research (PAR) approach, community members mobilised resources to provide masks, soaps and sanitisers and improve the accessibility of a clean water supply for the entire community. Therefore, this research has direct relevance to Sustainable Development Goals: 2 Ensure healthy lives and promote wellbeing for all; and 6 Ensure a availability and sustainable management of water and sanitation for all. The findings provide an approach to RRCE that is applicable more widely to geographically hard to reach communities in other countries on the Development Assistance Committee (DAC) list countries. There is emerging evidence of positive impact for individuals engaged in the PAR groups, with reported increase in levels of confidence and engagement in the course of the process; participants have indicated a desire to continue with a form of grass-roots community decision making beyond the conclusion of this project, and this could be sustained with our local NGO partners and become a legacy asset for them. Gender is a central consideration in this project, with Pakistan ranking at 151 of 153 countries in regard to gender equality (Global Gender Gap Report 2020). Due to the pre-existing gender inequalities and socio-cultural norms, women have been disproportionately affected by the social and economic fallout from the COVID-19 pandemic. Finding ways to engage women in this community to ensure that their voices were heard in the community decision making process was therefore essential. We did this by engaging male and female community members separately in both PAR and focus groups to ensure that women are empowered to speak freely and centring research activities around the local community school. The wider community including non-participants will benefit from improvement of the water supply in the area and employment of local staff (including specific roles for women and young community health champions in our research team). We have been invited to contribute to both interagency (lead by Save the Children) and Pakistan government RCCE groups. We have several meetings with Abbass Khan, Communication for Development officer UNICEF and with Dr Iftikhar Uddin, team lead Risk Communication and Community Engagement Task for COVID-19 Health Department in Khyber Pakhtunkhwa where we have had the opportunity to contribute our learnings to national and international RCCE efforts. We continue to be recognised as experts in this area by leading organisations in this area. Over the last 12 months we have continued to work with UNICEF and the Department of Health in Pakistan to improve RCCE practices and vaccine hesitancy in Pakistan, including facilitation of two workshops organised by UNICEF in collaboration with the Department of Health KP. These workshops reached over 150 people, including government, NGO and health care professionals and religious leaders. |
| First Year Of Impact | 2021 |
| Sector | Healthcare,Government, Democracy and Justice |
| Impact Types | Cultural,Societal,Policy & public services |
| Description | Capacity building of local researchers |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Our project has enabled us to develop our existing research partnership with Khyber Medical University. We encourage our research partners to lead on wider training and research activities, including journal and presentation authorship. We have also employed two research assistants and a project manager from Khyber Pakhtunkhwa (managed by our research partners at KMU) to assist in the conduct of the research. We have trained young members of the community to become lay health champions, providing them with transferable skills in communication and liaison as well as research methods. We anticipate that this role will contribute to the income of some families and the future employability of these workers. |
| Description | Contribution to national and international RCCE action groups |
| Geographic Reach | Asia |
| Policy Influence Type | Contribution to a national consultation/review |
| Description | Project collaborators and partners |
| Organisation | Khyber Medical University |
| Country | Pakistan |
| Sector | Hospitals |
| PI Contribution | UCLan's contributions include research management, knowledge and expertise, data management, data analysis, capacity building. |
| Collaborator Contribution | The project partners have contributed in many ways to the ongoing success of this project, including knowledge and expertise, management of field work, stakeholder engagement, community engagement, participant recruitment and retention, data collection, data entry, capacity building. |
| Impact | None yet |
| Start Year | 2020 |
| Description | Project collaborators and partners |
| Organisation | The Abaseen Foundation U.K. |
| Country | United Kingdom |
| Sector | Charity/Non Profit |
| PI Contribution | UCLan's contributions include research management, knowledge and expertise, data management, data analysis, capacity building. |
| Collaborator Contribution | The project partners have contributed in many ways to the ongoing success of this project, including knowledge and expertise, management of field work, stakeholder engagement, community engagement, participant recruitment and retention, data collection, data entry, capacity building. |
| Impact | None yet |
| Start Year | 2020 |
| Description | Interdisciplinary Approaches to Covid-19 Workshop, Royal Holloway |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | The aim of the workshop is to identify and create a COVID-19 research network within and beyond Royal Holloway in order to best position RHUL researchers to bid for COVID-19 collaborative grants. Over 30 inter-disciplinary attendees, future meetings planned. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Invitation to join RCCE Sub-Group Meeting on Community Engagement in Low Resource Settings |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Third sector organisations |
| Results and Impact | We have been invited to join the interagency RCCE Sub-Group Meeting on Community Engagement in Low Resource Settings. Co-led by the READY Initiative, IFRC and Internews as part of the Collective Service for Risk Communication and Community Engagement, this inter-agency working group meets every month to strengthen practices and resources for safe, participatory and inclusive community engagement that leverages local capacities in low-resource settings. The working group usually has between 20-25 participants from UN agencies, INGOs/NGOs and donors. We have presented our findings and contribute to regular discussions on how to improve RCCE avtivities. |
| Year(s) Of Engagement Activity | 2021,2022 |
| URL | https://www.rcce-collective.net/ |
| Description | Liaison with Department of Health and UNICEF RCCE leads |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | We have had several discussions with the RCCE lead for Khyber Pakhtunkhwa Department of Health and the UNICEF team for RCCE about our work. Part of the discussions centred around culturally appropriate modifications to the WHO RCCE toolkit that we have used in our research. |
| Year(s) Of Engagement Activity | 2021 |
| Description | One Day Training Workshop on Risk Communication & Community Engagement and Interpersonal Communication (IPC) |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | UNICEF in collaboration with Health Education & Communication Cell, Department of Health KP, organized One Day Training on RCCE and IPC skills for JSI's partner staff* in Khyber Pakhtunkhwa to promote COVID-19 vaccination uptake (among female and vulnerable groups), and address vaccine hesitancy. Members of our project team facilitated a full session on Risk Communication & Community Engagement and Interpersonal Communication (IPC) and explained in detail our methodology and results. This took place 21 April 2022 in Peshawar. More than 100 participants participated from academia, ministry of health, UNICEF and National health services *John Snow, Inc. (JSI) is a global public health consulting organization dedicated to greater health equity and improving the health of individuals and communities, and providing an environment where people of passion can pursue this cause. JSI provides technical and managerial assistance to public health programs worldwide. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Workshop organized by UNICEF and Department of Health Mansehra on Risk Communication and Community engagement for religious leaders and Civil Society Organizations |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Members of the project team facilitated a workshop organized by UNICEF and Department of Health Mansehra on "Risk Communication and Community engagement for religious leaders and Civil Society Organizations" in which we discussed our project in detail. dated 13th Oct 2022 at Khyber Medical Institute, IHS, Hazara. Participants included Medical officers from health department, nurses, last health visitors, community workers and religious leaders. |
| Year(s) Of Engagement Activity | 2022 |