Background
Definition of Community Mobilization
Citation | Definition | Central theme |
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[42] | “A process of creating and harnessing the agency of the marginalized groups most vulnerable to HIV/AIDS, enabling them to build a collective, community response, through their full participation in the design, implementation and leadership of health programmes and by forging supportive partnerships with significant groups both inside and outside of the community” | Campbell et al. (2010) - Community participation - Collaboration between community and professionals - Identity - Indigenous actors |
[45] | “Community mobilization is defined as a component of externally- triggered HIV interventions, rather than including indigenous community mobilization initiated by grassroots actors with broader interests than HIV.” | Cornish et al (2014). - Collaboration between community and professionals |
[46] | “A participatory approach, which involves building on local competences and strategies by ensuring that community members take part in decision- making and bring local knowledge, experiences and problems to the fore.” | Tripathy et al (2012) - Use of local knowledge - Community participation - Use of indigenous resources |
[25] | A capacity building process through which community members, groups and organizations plan, implement and evaluate on a participatory and sustained basis to improve their health or other conditions either on their own initiative or stimulated by others | Howard- Grabman et al (2007) - Local initiatives - Capacity building - Community participatory |
[47] | “Community mobilization constitutes active involvement of the community in information sharing , consultation, collaboration and empowerment strategies aimed at bringing change in communities” | Rifkin (2001) - Use of indigenous strategies - Collaboration - Community involvement - Community mobilization as a process/continuum |
[48] | “Community mobilization is seen as health promotion intervention which helps communities to identify and undertake appropriate actions in relation to shared problems. Further, there are two types of community mobilization strategies: community organization and building, and community advocacy. The latter assumes involving citizens in institutions or decision which have an impact on their lives” | McKenzie (2013) - Health promotion intervention - Cooperation for collective action - Involvement of community - Community advocacy - Community support |
[49] | “Community mobilization is seen as a process where people come together to take action on an issue by relaying on enhanced social connectedness and efficacy or the ability to have influence and control over their situation” | Watson- Thompson et al (2008) - Peer support - Community cooperation |
[50] | “Community mobilization is defined as individuals taking action organized around specific community issues. It involves community empowerment, community participation, capacity- building, community coalitions, community organization and development” | Kim- Ju et al (2008) - Community involvement - empowerment, - Capacity- building - Community coalitions - Use of community resources |
[51] | “Low- cost, participatory, community- based approaches involving women's groups aimed at effectively improving home delivery practices and birth outcomes in a range of settings” | Nahar et al (2012) - Participatory low cost - Community based strategies - Use of community resources |
[21] | “A health promotion strategy best seen as a continuum of process which include, Community informed of decisions made, Community consultation about decisions tokenistically to gain buy in, Community’s views taken into account, Joint decision- making , and Community driven decision- making” | Rosato et al (2006) - Tokenistic - Cooperation - Community consultation - Joint effort - Support |
[52] | “Community mobilization is the process of engaging communities to identify community priorities, resources, needs and solutions in such a way as to promote representative participation, good governance, accountability and peaceful change” | Mercy- corps (2009) - Community engagement - Use of Community resources - Community priorities - Community strategies |
[19] | “Actions that engage and galvanize community members to take action towards achieving a common goal” | Lippman et al (2013) - Engaging community members - Galvanizing community members |
Methods
Community mobilization OR community networks OR community groups OR Community coalitions OR community-based OR participatory OR Traditional birth attendants OR community mobilization OR community OR Community engagement OR indigenous strategies OR Local initiatives OR collective action |
AND [postnatal care OR Prenatal OR ANC OR emergency obstetrics care OR maternal mortality OR complications during pregnancy OR duration of postpartum stay at hospital OR duration of postpartum stay at home OR community care OR Transmission of HIV from Mother to Child] |
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reported studies conducted in sub-Saharan Africa
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reported results in English
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reported on community-based initiatives that engaged one or more community groups in concrete participatory activities in designing maternal care initiatives, or used indigenous resources in maternal care provision, or relied on peer support for pregnant women or new mothers.
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have been peer reviewed
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must have made use of an experimental research design, i.e. a randomized trial or a quasi-experimental design..
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must have also been conducted between 1990 and 2015 reflecting the period when HIV became a serious epidemic in sub-Saharan Africa.
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must have evaluated the initiative in terms of process indicators and quantifiable biomedical maternal health outcome indicators as defined by WHO. These include:a) Process indicators for maternal health, which capture changes in behavior of pregnant women and new mothers. These changes in behavior are usually a direct result of activities of a given maternal health promotion activity and they may include indicators such as: adoption of maternal health-enhancing behavior, increased access to health facility, adherence to antiretroviral therapy if living with HIV, attendance to antenatal and postnatal care, etc. Although useful, these indicators in themselves do not provide information on the results and impact of the activity [2, 26].b) Quantifiable biomedical maternal health outcome indicators, which capture the eventual health status of the target population and can be divided into [1, 16, 27]: primary outcomes (incl. complications during pregnancy and during childbirth, duration of postpartum stay at hospital/community care at home and maternal depression, such as antenatal and postpartum depression); secondary outcomes (incl. postnatal care and emergency obstetrical care, maternal mortality); other outcomes (transmission of HIV from mother to child).
Results
Characteristic of the publication | Number of publications (%) | Category 1 (HIV-) | Category 2 (HIV+) |
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Operationalization of Community Mobilization | |||
-The role of group/peer support for pregnant women or new mothers | 5 | ||
-The role of Traditional Birth Attendants (TBA) in maternal care provision | 5 | [35] | |
-The role of partnership between community and professionals in designing initiatives | 5 | [40] |
HIV negative (category 1) | |||
Process outcomes: | Value reported | Number of publications | Publication reference number |
Health-enhancing behavioral | Positive change (e.g. increased access to health facility, enhanced the pregnant women’s knowledge on how to handle maternal complications) | 6 | |
Outcome indicators | |||
Depression rate | Reduced depression | 3 | |
Maternal mortality | Reduced maternal mortality | 2 | |
Hemorrhage/sepsis | Reduced hemorrhage | 1 | [34] |
HIV Positive (category 2) | |||
Process outcomes: | Value reported | Number of publications (%) | Publication reference number |
Health-enhancing behavioral | Positive change: increased maternal health knowledge, Increased utilization and access to health-enhancing resources e.g. antenatal & primary healthcare, PMTCT, information on safe delivery services) | 5 | |
Outcome Indicators | |||
Depression rate | Reduced depression | 1 | [30] |
Maternal mortality | Reduced maternal mortality | 0 | |
Hemorrhage/sepsis | Reduced hemorrhage | 0 |
Citation | Country | Study Design | Community Mobilization Component | Process results | Outcome |
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1. [36] | Tanzania | Longitudinal | Community Capacity Building & Empowerment support for village health workers; (2) developing community-based plans for transportation to health facilities; & (3) increasing participation by community members in planning; | Significant improvement in access t health facilities due to increased transport options Increased attention to Obstetric complications by 275 Deliveries attended by a relative/community member or no one decreased 4% & 6%, respectively but by a TBA increased 200% | |
2. [8] | Malawi | randomized controlled trial | Established participatory women’s groups to mobilize communities around maternal and newborn health | A combined community and facility approach using participatory women's groups and quality improvement at health centers reduced newborn mortality in rural Malawi | |
3. [17] | Malawi | Randomized trial | Established Community women’s groups to ensure provision of socioeconomic support | Better health outcomes for infants reduction in disease for both mother and child Better health-seeking behavior Increased Uptake of HIV testing | Reduced MMR, NMR and IMR in treated group, Conclusion: Community mobilisation through women's groups and volunteer peer counsellor health education are methods to improve maternal and child health outcomes in poor rural populations in Africa. |
4. [37] | Kenya | Randomized control trials | Involvement of Community Health Workers in provision of maternal health services | Increased visits to health center, increased deliveries by skilled personnel, “Conclusion increase in essential maternal and neonatal care practices | |
5. [38] | Ethiopia | randomized controlled trial | Mother to Mother support in recognizing maternal health risks | Reduced MMR, NMR and IMR in treated group | |
6. [34] | Angola | longitudinal | Involvement of traditional birth attendants (TBAs) prenatal, delivery, and postnatal care | Better MMR, NMR and IMR outcomes | |
7. [33] | Sahel | Longitudinal | Involving TBAs to promote safe motherhood | - High levels of retained knowledge of risk factors, hygiene and malaria prophylaxis in 2-year followup survey. - Low levels of knowledge of postpartum haemorrhage management, low number of births attended for most” | |
8. [27] | Nigeria | Longitudinal | “Involved traditional birth attendants (TBAs) in a rural community maternal health care provision | - Increased referrals to health centers increased use of family planning | Reduced haemorrhage, oedema, extended labour cases |
14. [18] | Sudan | Longitudinal | Involvement of Village TBAs to detect high-risk pregnancy and newborns complications | Increased reporting of complications Increased detection of complications | 25% reduction in cases of stillbirth and neonatal death |
Citation | Country of origin | Study Design | Community Mobilization Component | Process results | Outcome |
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1. [30] | South Africa | Randomized Controlled Trial | Involvement of fellow HIV positive pregnant women to mobilize and provide support to fellow HIV positive mothers. | - Women in Treatment Group (TG) exhibited Increased knowledge on how to improve the health of their children - Increased access to information and resources to improve their health during maternity | - Mothers in Treatment Group (TG) exhibited reduced maternal depression when compared to their counter-parts |
2. [31] | Tanzania | Randomized controlled trial | Creation of peer support group that provided a safe space for women with high levels of psychological distress to discuss and share strategies for addressing common concerns related to PMTCT among HIV positive pregnant women. | - Increased disclosure among HIV positive pregnant women in the treatment group as compared to those in the control group. - Women in Treatment Group experienced a significantly higher rate of overall personal satisfaction with response to disclosure, | - a marginally significant reduction in the level of depressive symptoms for HIV-positive pregnant women participating in a group counseling intervention (Treatment Group) 60% of women in the intervention group were depressed post-intervention, versus 73% in the control group [Relative Risk (RR) 0.82, 95% confidence interval (CI): 0.671.01, p0.066]. H |
3. [32] | South Africa | cluster randomized controlled | The intervention consisted of four antenatal and four postnatal small group sessions led by Peer Mentors, in addition to Standard Care. HIV positive pregnant Women were recruited during pregnancy and 70 % were reassessed at 1.5 months post-birth. | Compared to Standard Care WLH, EI (treatment Group) were more likely to ask partners to test for HIV (OR = 1.84; two-sided p = 0.014), | Compared to Standard Care WLH, EI (treatment Group) were more likely to have infants with height-for-age z-score ≥ –2 (OR = 3.30; p = 0.006) and were less likely to report depressed mood (OR = 2.55; p = 0.003). - Healthcare utilization was similar across conditions. - Significant improvement in PMTCT |
8. [40] | Zambia | (Longitudinal ) | Healthcare workers (HCWs) and lay providers conduct rapid HIV testing. support for pregnant women,” | Uptake of services significantly improved HIV testing among pregnant women improved - There was also significant improvement in the percentage of HIV positive pregnant women referred for clinical care |
Overall characteristics of publications
The role of Community Mobilization among HIV negative women (Category 1) and HIV positive women (Category 2)
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Use of traditional birth attendants (TBA) in maternal care provision
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Collaboration between community and professionals in designing and/or implementing initiatives