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Community engagement in public health interventions for disadvantaged groups: What's the evidence? | Health Evidence | YouTubeToText
YouTube Transcript: Community engagement in public health interventions for disadvantaged groups: What's the evidence?
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Video Summary
Summary
Core Theme
This webinar presents findings from a systematic review and meta-analysis on the effectiveness of community engagement in public health interventions for disadvantaged groups, highlighting that such interventions are generally effective but require tailored approaches.
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Good morning everyone. This is Olivia
Marquez and I'm a team member with
Health Evidence. It is my pleasure today
to welcome you to our very special
monthly webinar series. And today we
will be discussing community engagement
in public health interventions for
disadvantaged groups. What's the
evidence? So today we will be going
through a few polling questions
throughout the session. Uh this is just
a slide to note your consent. We will
not be sharing uh any of the information
uh that you provide through the polling
anonymous. After today, the PowerPoint
presentation and the audio recording
will be made available uh through health
evidence slides share account and the
health evidence YouTube account. So the
links to those resources will be posted
in the chat section on WebEx. So that's
on the right hand panel within
WebEx. And today we will be discussing
um the review the effectiveness of
community engagement in public health
interventions for disadvantaged groups a
metaanalysis. And again the the link to
this review within health evidence will
be posted in the chat
section. So just a few housekeeping
items before we begin. Please use the
Q&A and chat function in WebEx to post
your questions or comments. We ask that
you please send your questions or
comments to uh all participants and not
just to the host. But if you do, it's
not a problem. We will still see uh your
posts and comments come through. Towards
the end of the session, we will have a
uh opened question and answer session
and I'll be able to read your questions
aloud to our presenters to respond. You
don't need to wait until the end of the
session to post your questions. You can
through. And for your best connection
today, we recommend you use a wired
versus wireless internet connection. And
for the audio, please listen through
your speakers and make sure to go to the
communicate tab at the top in WebEx and
click audio connection. Should you have
any issues today, WebEx has a 247
helpline that you can call to help get
you connected. Again, this information
will be posted in the chat section as well.
well.
So, we have our first polling question
today uh before we get started and we're
wondering how many people are watching
today's session with you. Are you by
yourself? Do you have one or three other
individuals with you, four to five, 6 to
10, or a larger more than 10 group? So,
thank you to those who are responding.
Please make sure to select your response
and then click submit at the bottom.
So we see quite a few people are by
themselves and we have a few other
people who are joining uh in larger
groups today. So that's great. Thank you
responding. Okay. And just a special
thanks before we get started to the
large team at Health Evidence who helps
to coordinate our monthly webinar
series. Uh as many of you know we have
been uh away from our monthly webinar
series over the summer. So, we're very
excited to uh reintroduce our session
fall. So, for those of you who may be
unfamiliar, Health Evidence launched in
2005 and we are a comprehensive registry
of reviews evaluating the effectiveness
of public health and health promotion
interventions. We provide over 90,000
visitors per year access to over 4,700
quality rated systematic reviews. We
provide links to full text, plain
language summaries, and podcasts were
available. One of our main goals of
health evidence, in addition to making
evidence on the effectiveness of public
health interventions more accessible, is
to make it easier for professionals to
So the value added for using health
evidence is that we've helped save you
time. We've done the work to screen and
appraise each review within our
repository. We screen all reviews for
relevance to public health and keep our
registry up to date by constantly
screening relevant databases and list
serves. So at any given time, we're no
more than about one to two months behind
the publication date.
We have done the work for you by
critically appraising all reviews
through a transparent process whereby
you can actually click on the full
quality assessment for each review
within our registry and see the rating
uh for each of our 10 assessment
criteria. So healthevidence.org or has
various tools and supports for uh
evidence-informed decision-making which
is available on our website
uh which again the links to that will be
posted in the chat section and through
the years many of our users have
informed us that our tools and
So here we see on the slide a model for
evidence-informed decision-making in
public health which consists of five
components that you can see in the
diagram. So traditionally public health
practitioners and decision makers
consider evidence about community health
issues and local
contexting resources and community and
political climate when making decisions
about programs and policies. However,
it's become more apparent that
considering evidence uh about research
may be more
challenging. As such, the health
evidence webinar series is designed to
identify research evidence relevant to
public health decisions and helps
So here on the slide we have uh the
stages of the process of
evidenceinformed public health that you
can see on the wheel and the wheel is a
guide for practitioners and decision
makers to determine how to address a
particular issue by systematically
incorporating research evidence in the
decision-making process. So there are
seven steps in this process. Uh starting
with clearly defining the problem. We
will hear today about how our presenters
have worked through the first four steps
in this process in order to help with
decision makers with the remainder of
the seven
steps. So we have our second polling
question which we will open in just a
moment. and we're wondering if you have
heard of Picos before. So, if you're
familiar with this, again, if you can
make sure to select your response and
screen. So, thank you to those who are
responding. Uh we have so far about a
half and half split between yes and no.
So please continue to uh respond to that
question and we'll move on to our next
slide where we'll go over what POS
actually stand for. So POS is a way for
you to structure your questions in a
defined set in evidenceinformed
decision-m and it involves defining who
the population is that you're interested
in what the intervention is that you
want to know about the comparison group
if any and sometimes this can be a
little bit difficult to consider within
the realm of public health and any
specific outcomes that you're looking
for. So sometimes we also have a
particular setting in mind which could
be for example school or today we're
considering community settings. The
value of a pico question is that when
you have an issue that arises you can
use pico to turn this into a searchable
question which allows you to further
articulate specific components of the
question that help you to hone in on
that question. Searching for relevant
information then uh to your pico
And we'll move into our uh third polling
question today. Just before we get
started, we're wondering uh how often do
you use systematic reviews to inform a
program or
service? So, always, often,
sometimes, never, or you may not be
familiar with what a systematic review
is. So, we'll just open up that polling
question. uh in a moment and we'll get
an idea of
with. So, thank you to those who have
started to respond. We have uh a few who
always use systematic reviews, which is
really great to hear um often and
sometimes, and a few who may never use
systematic reviews or are not sure what
a systematic review is, which is uh
completely fine. We hope that today's
session will enlighten you on what a
systematic review actually is. So
continue to answer those questions and
in the meantime uh we'll bring us back
to our presentation. And today it is my
pleasure to be inviting Allison Omar
Eaves and Jenny Brenton today from
London who are presenting on their
systematic review. So thank you Allison
and Jenny for joining us today. I will
pass the ball along to you and let you
Okay. Well, thank you very much for
that, Claire. This is Jenny Bruntton
here. Um, and my colleague Allison.
Hello. Um, we're going to uh talk to you
about our research today. Um, we
appreciate the opportunity actually to
to talk about this. This is a large
systematic review that we undertook um a
few years back uh looking at whether uh
public health interventions that engaged
the community in some way improved
health related outcomes particularly for
disadvantaged groups and uh that was
about a two-year program of work.
Allison and I work uh at that building
uh near that building there that's the
Institute of Education and it's part of
University College London. We work in
the a research unit called the evidence
for policy and practice information and
coordinating center which happily we
shorten to epicenter. Um and as I say
that's part of the department of social
science at UCL London.
So just to tell you a little
bit about this
um project, it was funded by the UK
National Institute for Health Research
or NIHR. And uh this was a large
multi-group project that we undertook
with colleagues at the London School of
Economics uh University of East London
Center. And the final report that
resulted was a whopping 548 pages. I
think that's still the record for the
largest report we've ever published. Um,
and it's uh this large because there are
multiple syntheses in it. Uh, so we're
going to try to break it down into a
much more digestible nugget for you all
today. Um, today we're going to talk
basically about our our definitions of
community engagement and health
inequalities that we used, a little bit
of the background about the research
project, the why and how, and then two
of the synthesis that we undertook from
that systematic review. a theory
synthesis that looked at conceptual
understandings of community engagement
and a meta analysis that looked at the
effectiveness of community engagement
initiatives and then just some
conclusions to draw it all
together. So the research topic well
it's probably helpful to have a look at
what we mean by community engagement. Um
we define that as a a direct or indirect
process of involving communities uh in
decision-making and or in the planning,
design, governance and delivery of
services. And that might be done uh
using any combination of methods of
consultation, collaboration uh or
community control. And that's quite a
broad definition. Uh community
engagement can therefore take many
forms. And some examples of those are
some of these ones that we've listed
here. Community coalitions are quite
often talked about. Uh peer delivery of
interventions is also a form of
community engagement, public
on. But we're also interested in
community engagement in relation to
health inequalities. And health
inequalities here are uh socially
determined differences in health
outcomes. So these the causes of these
are generally modifiable. So for
example, you could change somebody's
social economic status or you could
improve social exclusion or reduce
social exclusion. Um those are
modifiable things that you can you can
target uh rather than sort of biological
causes such as a genetic predisposition
for a disease. uh and um Sir Michael
Marmmet uh has done a lot of work uh in
England uh looking at uh inequalities in
health and he uh produced a report in
2010 for the secretary of state for
health which is like the minister of
health in in England uh called uh fair
society and healthy lives and this was a
review to propose the most effective
evidence-based strategies to reduce
health inequalities in England going
forward and and that report his team
identified four key modifiable health
risks. Smoking, alcohol abuse, substance
abuse, and obesity. So very firmly
placed in in the public health realm.
realm.
Um he the team also suggested that
reducing health inequalities requires
action in six very broad priority areas
and they're listed here for you to have
a look at. You know, it has to do with
things like giving children the best
start in life, allowing people to
maximize their capabilities, provide
fair employment, a healthy standard of
living, healthy and sustainable places,
and strengthening the role and impact of
health prevention. Now, I mention these
here now because we utilize these later
So when you're thinking about community
engagement and health inequalities
together, community engagement is, we
argued, particularly suited for
disadvantaged and socially excluded
groups. Um particularly because
community engagement is thought to
encourage social justice and it can give
a voice to the voiceless. So people who
might not otherwise be able to make
their needs known or um get change in
the way that is of the most benefit to
them. uh community engagement can also
produce interventions that might better
meet community's needs by you know being
more culturally competent or more
empathic to what a particular community needs.
So in terms
project, when you think about community
engagement, there's quite a patchwork of
theories about why community engagement
should be used and how community
engagement actually works. What does it
look like? Um there's a lot of
discussion uh about uh community
engagement from a lot of different
philosophical traditions and there's a
very unclear empirical evidence about
the effectiveness and cost effectiveness
of community engagement strategies. Uh
so there's lots of discussion about what
a great thing it is but uh we weren't
sure about the empirical evidence about
whether it was actually effective or
not. uh and you know coupled with that
there's a lot of uncertainty about the
processes as I said about how it works
um is there sort of a formula to undertaking
undertaking
it so we thought being good research
methodologists we should undertake a
systematic review and the process that
we undertook to do that was a standard
systematic review so we undertook
sensitive searches uh we uh and I'll
just go through this quickly and and
talk about how we modified it a little.
We undertook sensitive searches and we
looked for systematic reviews um but we
also looked for trials specifically
around community engagement. We
identified primary studies within
reviews or trials of community
engagement. We extracted data from these
studies on key concepts and
characteristics and we used that to
create sort of a broad map of
interventions so that we could try to
understand where community engagement
had been used with what populations,
what interventions, what kind of
outcomes and so on. And then we selected
particular interventions that targeted
uh marmet uh the priority areas.
Remember those six priority areas I was
talking about earlier um for our
in-depth review for our meta analysis
and from those we extracted
effectiveness data or outcomes data and
we assessed the risk of bias and then we conducted
synthesis. So when I say synthesis I do
mean synthesis. There were four
different syntheses undertaken. So we
did a metaanalysis of effectiveness. We
did a thematic synthesis of processes
from integral process evaluations. We
did an economic analysis of cost and
resource data. And we did a theoretical
synthesis of uh conceptual
underpinnings. Now, what I'm going to
talk about or Allison and I are going to
talk about today are just the results of
the theory synthesis and the metaanalysis.
metaanalysis.
um we thought it was probably important
to talk about the conceptual
underpinnings of community engagement
and how that structured uh the
metaanalysis that we ran
subsequently. So the first bit is the theory
theory
synthesis and just a brief bit about the
methods with that. As I said earlier,
there's a lot of theories about why
community engagement is important and
how it might work and there were lots of
discussion papers about why it perhaps
didn't work. Um we ended up extracting
data from that should say retrieve
studies. So it wasn't just included
trials, it was also data from key
discussion pieces. um what's sometimes
referred to as background articles and
from exemplar process evaluations so
that we had a broad range of types of
community engagement and uh a wide
philosophical base of discussion about
community engagement. We then grouped
the data that we extracted and we
iteratively developed themes and I tried
to illustrate what that looked like. So,
in this little diagram at the bottom,
I'm going to see if I can use my pointer
here. Um, I'm not sure I can use my
pointer. So,
don't I think I'll just I'll just talk
you through it. So, on the left hand
side at the top is discussion pieces or
process data. Um and we took data uh
data from those and we constructed a
conceptual framework that uh represented
all the characteristics that people
talked about uh of community engagement
that they thought were associated with
you know that intervention working or
not working. We constructed a conceptual
framework and we uh ran it past our
advisory group. So we had ongoing
consultations with uh an advisory group
to help us develop this conceptual
framework. When we thought that we had a
a initial conceptual framework
developed, we then looked at data from
the trials and where there was data from
the trials to inform the conceptual
framework. We added that uh but we used
the conceptual framework to actually
look for patterns uh in the trials that
might suggest some theories of change or
some mechanisms about how community
engagement was
working. And in the next slide,
oh thanks Alison. So in the next slide
um we ended up having a resulting
conceptual framework and I'm just going
to talk you through this. This is a very simplistic
simplistic
version of the conceptual framework. Um
so there there's the the set of studies
the overall set of studies that we
retrieved for this uh review. We ended
up having kind of two types of studies.
So they're represented by the two
triangles that you see on this on this
diagram. And the first one is uh a set
of studies that focused on community
engagement as an intervention in its own
right. And that might be things like um
improving park spaces in urban areas. Um
that sort of thing that might have
health outcomes attached to it. And then
there was another set of studies that
were looking purely at health
interventions um that might have some
aspect of community engagement within
them. So an example of that might be um
a breastfeeding a community
breastfeeding intervention that involved
uh uh mothers as peer deliverers who
might teach other mothers uh techniques of
of
breastfeeding. And so you have overlap
between those two sets of studies. You
might have some health interventions
that have lots and lots of community
engagement and you might have some
community engagement studies that have
uh more health intervention in them than
others. Um so within that we started
looking at you know what people said
about what worked and what didn't work
with community engagement in those sets
of studies and they ended up being um
thematically grouped into these six
areas. And so that those were things
like uh starting on the left hand side
uh needs and that's who defines uh the
community does is the community defined
um by uh say a government body uh saying
that you know for example pre uh uh
still birth in a particular community is
too high or is it uh the community
defines themselves as uh uh for example
a deaf community uh that they're uh they
self-identify. It might also be
um whether you're looking at populations
who have specific needs or are so
economically dev disadvantaged or
communities as I say who self-identify
or they may be geographic communities so
within a particular neighborhood. Um the
next uh theme over is the motivation. So
that's a bit about why do people engage?
Why do they do they do community
engagement or or maybe why they get
asked that maybe there's characteristics
around that that influence whether it's
successful or not. So people might
engage because they want to be
responsible citizens or they might see
that there's some community benefit to
doing it. Um government uh bodies may
invite people because they think it'll
lead to better services and health
leveraging resources. There might also
be theoretical underpinnings uh
motivating community engagement. So it
might be uh that interventions are based
on social learning theories or
behavioral theories. The next column
over is community participation and this
is really getting at the level and
extent of community engagement. So uh is
community are is the community involved
in design delivery and evaluation all of
them one of them two of them or is the
community leading collaborating
consulting being consulted or being
informed and obviously those are uh you
know different levels of
engagement. The next column over is the
conditions under which community
engagement takes place. uh there were
some uh studies that talked about uh the
mediators of community engagement. So
for example, if community members are
very competent at being able to
communicate and work in a coalition kind
of setting or not, that may influence
whether an intervention is successful.
Um but it may also be something to do
with the context in which the community
engagement takes place. So is the
intervention set up in such a way that
it's going to be sustainable over time
or will it stop when the funding runs
out? Uh and also what's happening in
government policy and uh are there sort
of targets that need to be met and do
those targets change and then that
changes the intervention. So those kinds
of things influence the type of
community engagement that goes on. Uh
next are the actions that are
undertaken. So that's actually the
process stuff about whether there's
collective decision making in the
community engagement that goes on. Um is
there training support for people? Is
there admin support for you know the
community engagement meetings to take
place for example? Um how often do they
meet? For how long do they meet? Those
kinds of um process things. uh some some
studies talked about the importance of
those and also things like
implementation the acceptability and
cost and feasibility and finally um
another theme around community
engagement was around the impact. So
that's all about the beneficiaries
whether it's the people who actually are
the community engagees or is it the
wider community that they're providing
the intervention to and that can be
community service providers, government researchers
researchers
um what kind of outcomes uh what uh are
impacted upon? So, are there outcomes
like health outcomes or are there other
things like attitudes, uh, mutual
learning, social capital, self-esteem,
and empowerment? And finally, are there
any potential harms from community
engagement? Some some studies did talk
about possible impacts because of social
exclusion or cost overrun or attrition.
Um, so there's lots of different
characteristics that have been discussed
that might influence whether community
engagement is successful or not.
And we basically took that information
and looked at the trials to identify any
patterns or any mechanisms that seem to
be operating uh as theories of change.
And what we came up with were four
theories of change that seem to be
operating. Um the first one was
empowerment where um people thought that
change was facilitated where a health
need is identified by the community and
they mobilize themselves into action. Um
there's uh a second and third theory of
change. Um I'll talk a little bit or
Allison will talk a little bit later
about why those are sort of grouped together.
together.
Um but these are community engagement uh
interventions that are based on a
thinking that the views of stakeholders
are sought in the belief that the
intervention will be more appropriate to
the participants needs as a result. And
then finally there's a theory of change
around lay delivery where community
engagement might be implemented because
um there's a thought that change will
happen because of the credibility or
expertise or or empathy uh that the
community member brings to the delivery
of the intervention.
So we had a look to see if there were
differences in uh trials uh in the the
effect sizes based on those um
conceptual underpins of the community
engagement intervention. So what I'm
going to do now is hand it over to
Allison and she'll talk to you a bit
about the meta
analysis. So hello, this is Allison
here. Um we've already established I
think and hopefully it's come across
that this was a massive piece of work.
um we really put a lot of effort into
this and generated a magnificent and
beautiful report that is not the most
accessible because it is so huge. So
we've been trying to distill some of the
most important messages out uh for
different potential users. So we've
produced some publications around some
of the method stuff that we did um but
also for policy makers and practitioners
and decision makers. Um so we're trying
to make it a little bit more accessible.
So this we're really um we appreciate
health evidence and we're we're grateful
for this opportunity to try and get
across some of the messages from the
meta analysis because it was big and
it's hard to to get that message across
um in writing. We have produced a
journal article which is a mere 23 pages
um that covers the key points the meta
analysis. So if you are interested in a
bit more about how we did the statistics
and also some of the the actual results,
we're giving headline findings here, but
if you want to get into a bit more of
the actual results, um we it it is worth
having a look at this uh journal article
because it it breaks it down a little
bit. I got slightly distracted and you
may have heard me stutter for a moment
there because I just saw someone's
posters notes say, "Thanks for the
second shorter article." You're very
welcome. It was a pleasure to write and
I hope it's useful. Um, but now we're
going to run through some of what we
think were the key findings from this
shorter paper. Um, and hopefully uh
you'll find it interesting and a bit
useful. It's a bit of a whistle stop
tour though. So, I'm just going to go
through some of the descriptive
statistics and and um about the actual
studies that we included in the review.
Now the whole review we actually had 320
studies that we looked at but time and
budget constraints meant that we needed
to slim it down a little bit and also it
was it was
conceptually it was very diverse. So
what we did was we looked back at what
that Marmmet review that um that Genie
was mentioning earlier about fair
society, fair lives. uh we looked at
what some of the key policy messages
were in that that that they needed
evidence on to help address health
inequalities in England and I suspect
these the same issues are are similar
across the world. So hopefully there's
still relevance to to you outside of uh
the UK. Um, but we ended up narrowing it
down to studies that addressed some of
those four modifiable health risks that
Genie mentioned as well as the six
policy priority areas. And we ended up
with a set of 131 studies um that met
our inclusion criteria. And when we talk
about inclusion criteria, we're talking
about those PICO elements PICO
uh that Olivia mentioned at the start of
the presentation. Oh, Cla. Was that
Claire? Sorry. Um Oh, yeah. Sorry for our
our
Sorry, sorry, sorry. Um, so just to give
you a bit of a sense of what the
database, the you know the set of
primary studies that we analyzed um in
the following sections what they looked
like. Um there was a range of countries
but the vast majority were from North
America. uh studies 90% of the studies
were conducted in in North America. Um
obviously we had a a population interest
in in health inequalities issue and we
we coded information or tried to um
represent different types of of
potential health inequalities in the
literature but the most common
um health inequality that was mentioned
in the studies uh was that of ethnic
minority groups. uh followed by low
soioeconomic position um populations.
There were also a sizable number of
studies that uh addressed multiple health
inequalities. We covered a vast um
variety of health topics. Um I'm not
going to go through all of them, but you
can see the most commonly represented um
interventions were in the areas of
substance abuse, cardiovascular disease
um and breastfeeding. Um but there was a
whole range of different health topics
that were covered uh in the literature.
Basically, community engagement is used
in a lot of different aspects of public
health and health promotion.
We also looked at a number of different
types of outcomes. Um our primary focus
was on health behaviors because of our
mission to to try and understand um
these modifiable health behaviors. So
health behaviors included things like
the the extent and duration of
breastfeeding or whether people attended
cancer screening or or attempts to quit
smoking, things like that. We were also
interested in any health consequences
that were measured. So by health
consequences, we mean things that are
likely to result from a change in a
health behavior. So things like
mortality or diagnosis of an illness or
a particular
condition and we saw 38 studies measured
some kind of health consequence. We were
also interested in psychosocial outcomes
um particularly participant
self-efficacy. Now, self-efficacy is a
person's belief that they can change
their own behaviors. So, do they have
the ability to quit smoking? Do they
feel capable of quitting smoking as an
example? Uh 20 studies looked at
participants self-efficacy. And we also
looked at social support. So, whether
the participants in the interventions
felt that they were um better supported
whether by their peers, their
family, even strangers. um but did they
think they received um greater social
support as a result of being involved in
intervention and seven studies measured
some kind of social support. We were of
course very interested in um community
outcomes and what we called engage
outcomes. So these are outcomes for the
people that were um engaged in the
intervention either through the design
or the delivery of the intervention. So
these are the people that are
lay lay people that are involved in the
intervention in some way. Um
unfortunately very very few studies uh
measured any community or engaging
outcomes and where they did they were
completely different. They were defined
in such different ways that we we just
couldn't combine them statistically. Um
we do describe them narratively in the
report um but not statistically. So for
the eagle-eyived observer, you may have
noticed that we actually have more than
131 outcomes. Um 131 being the number of
studies that we analyze. This is because
many of the studies reported more than
one type of outcomes. So they often had
health behaviors and self-efficacy, for
example. So we conducted our analyses
separately for these different health
outcomes. And you'll see on this table
um the second column which is labeled
pulled effect size estimate. What that
number represents is the the difference
between the intervention group. So the
participants that actually received the intervention
intervention
um and the outcome of the the difference
between the intervention group and the
control group or comparison group. So
what we're measuring here is how much of
an improvement are we seeing in health
behavior or health consequence whatever
the outcome happens to be what is the
improvement in the intervention group
relative to the control group. When we
see a positive number so a number that's
greater than zero that means that we are
seeing some improvement for the
intervention group relative to the
control or comparison group. When we see
those little asterisks or little stars
next to that number in the second
column, that tells us that the result is
statistically significant. And you'll
see that for all four outcomes that we
looked at, health behaviors, health
consequences, self-efficacy, and social
support, all of those were statistically
significant, which means for all of our
outcomes, the intervention group
performed better than the control group
um at the completion of the intervention.
intervention.
So, that's a nice finding and we were
excited by that and we were pleased by
that and that's why we had the little
dude with the um the the what balloons.
I was about to call him my
umbrellas the balloons cuz we're very
excited about this finding. In general,
these community engagement interventions
are effective. However, you'll also
notice towards the right hand side of
this table uh the section called
heterogeneity. And what this section is
telling us, we run statistical tests to
determine whether the um results are
likely to have occurred by more than
just chance and also whether there's
variation amongst the studies that needs
to be explained. We found there was
significant statistical heterogeneity.
So the studies differ from each other in
some sub substantial way. Um which we
don't see this as a limitation. And we
see this as an opportunity to try and
understand why these work differently
for different people in different
contexts. We wanted to attempt to
explain that variation between the
studies by conducting moderator and
regression analyses. If you're familiar
with statistical analysis in primary
research, the moderator analyses are
basically uh like your anovs except
you're using summary statistics rather
than individual patient or as individual
participant data. Um and the regression
analyses are very much as you would um
conduct again in in primary research. So
hopefully these concepts are a little
bit familiar to you. If they're not, if
you're not particularly quantitatively
inclined, uh you'll just have to trust
us that this is how we explore variation
uh in the in the studies. Um the
analyses that we conducted uh were
generally on the health behavior
outcomes because most of the other um
outcomes, so the consequences,
self-efficacy, and social support. we
had a smaller number of studies and once
you start breaking it down into
subgroups uh you end up with too few
studies in in each type of um in each
category of the subgroup. Um so the bulk
of the results that I'll presenting
going forward relate to health behaviors
only. So as uh you may have guessed from
Jeanie's uh wonderful introduction we
were really interested in theories of
change. We wanted to know what was the
underpinning reason why people would
expect engaging members of the community
in these interventions should work. So
we did an analysis to see whether there
was any difference between the studies
depending on what theory of change
underpins the
intervention. You can see uh in this
table we've got five rows. So the first
four rows are uh
representing I'm just trying to get some
kind of little tool to indicate this.
First four rows are representing the
different theories of change. Um so the
first one is the community identified
the health need which is aligned kind of
empowerment models. Then we have our
collaboration to design more appropriate
intervention and cons consultation to to
design more appropriate intervention.
Now these two um types of theory change
are very similar in terms of how um why
they would expect uh community
engagement to work. The difference is
the extent to which the community is
involved. So in the first type
collaborating the the engaged people
have a very active role in designing an
intervention but in the um the next one
or consultation they're they're
basically told what what's going to
happen in the intervention and they can
suggest changes but they're not as
actively involved in the design. And
then finally we have um delay delivered
uh models of theories of change. Now you
can see from the second column here that
um they're all positive and they're all
statistically significant. So again we
have this happy finding that regardless
of the theory of change used we are
seeing benefits of the intervention
relative to the control group or the
comparison group which is statistically
significant for those that are uh quite
king. Again, um you'll notice that there
is a final row which is other theories
of change. There were seven naughty
renegade studies that didn't cooperate
and didn't fit in with uh any of our
four definitions of the theories of
change. Um so we we group those
togethers as un un pigeonhaulable.
uh and you'll see there was no
significant difference um from the
intervention group to the control group
for those studies and that's probably
due to the the heterogeneity. So the
studies are basically too different from
each other to to really observe any clear
clear
trend. Uh so they're the main highlights
from this um this table and that's one
of the most exciting findings from the
study is that regardless of which um
theory of change underpins it we're
seeing benefits. We did observe
obviously that lay delivered tended to
be the most effective. Um but we noticed
that there was a bit of a difference
between the typical sample size in the
um in the studies that use these
different theories of change. So those
that were lay delivered although they're
the most effective they also tended to
be the smallest studies um and we also
noticed through other um analysis and
observation of the studies that these
tended to be quite intensive
interventions with lots of one-on-one
treatment. Um so a typical example here
is breastfeeding interventions where um
mothers that have previously breastfed
go and out to women's homes and help
them um establish breastfeeding with a
new child. So they're very intensive,
very personal intervention. So in some
ways it's not that surprising that
they're quite effective because they're
uh they tend to be quite focused um kind
of interventions.
We looked at a whole bunch of other
moderators that I would love to go into
more detail, but we're running out of
time and I'd like to have some time for
questions for you. So, I'm just going to
skim through the highlights. The one is
single component interventions tended to
be more effective at improving health
behaviors than multiple component
interventions. Um, and a lot of people
have talked in in the literature why
this might be the case. Uh, so if you're
having multiple components, it can um
overwhelm participants. um they can get
intervention fatigue and there's also
sometimes the issue of dilution of the
key messages. Um so that might be why
that's why we're observing that. We also
uh observed that universal
interventions, so those that were
delivered to the kind of the whole
population, so citywide for example,
tended to have higher effect sizes than
um those that were targeted
interventions just at those that had a
kind of a health need or a deficit in a
particular um area, particular health outcome.
outcome.
uh we observed that interventions that
were conducted in non-comm community
settings so these are things um like in
the home or uh in educational settings
or primary care settings things like
that um so non-com community settings
tended to be more effective than those
uh in terms of the features of the
interventions themselves um
interventions that employ skill
development or training strategies or
which offered contingent incentives. Now
the contingency is very important. If
you just reward people regardless of
whether they uh change their behaviors
or not, that's not going to work. You
need to only reward good behavior
basically. Um these tended to be more
effective than those employing purely
educational strategies. So if you're
just giving people information, uh that
on its own um wasn't as effective.
interventions that involved peers,
community members, or education
professionals tended to be more um
effective than those involving health professionals
professionals
alone. And shorter interventions tended
to be more effective than longer
interventions. Um but as I kind of
alluded to earlier when I was discussing
lay delivered interventions, this is
probably confounded by levels of
exposure or intensity of contact with
the intervention deliverer. So the
shorter interventions tended to be very
personalized intensive interventions
whereas longer ones were things like
media interventions or um introducing
cycle paths and things like that. So
they they're much broader. So you may
not expect to see um such big big
gains. Um in terms of the participants
interventions tended to be most
effective in adult populations and less
effective in general populations. And by
general populations, I mean delivered to
the whole city or area. So they're not
um targeting specific age groups. And
interventions tended to be most
effective for health behavior outcomes
uh for participants that were classified
as disadvantaged due to socioeconomic
position compared to the other different
types of health inequalities that we
looked at. So the
conclusions, yay, we were happy. overall
public health interventions using
community engagement um appeared to be
effective in terms of all of the
outcomes that we looked at at um one
thing that I didn't uh talk about in the
results here but they are covered in
both the report and the shorter journal
article um is that we we did test for
methological biases. So we looked at
risk of bias in the studies and the
findings did not appear to to be due to
those to any kind of systematic
methological biases. So um the findings
appear to be robust uh across different
methodological um type and quality
assessments that we did. Um however as
you can probably expect there's a lot of
unexplained v variation amongst the
effect sizes. We had a very diverse data
set and we knew that going to this. We
explicitly um set out to capture a wide
range of different community engagement
interventions in different health
settings. So we knew there was
heterogeneity or variation between the
studies before we even started the
analysis. We didn't need the statistics
to tell us that basically. Um but we
don't see that as a weakness of this
study. um we see that as a strength
because it gives us a rich data set to
start to explore some of this variation
and we know that there are probably um
lots of interaction effects. So for
example the fact that lay delivered
interventions tended to also coincide
with those that were more intensive and
more personalized. Um and and these
sorts of things we hope provide future
re researchers, potentially even
ourselves, um some guidance on ways that
we can start exploring this literature a
bit further and getting down to the the
nuts and bolts. Who really is this
working for, under what conditions, in
what settings, uh what outcomes and so
on. Um, we concluded in the report, this
is a quote from it, that the evidence
suggests that community engagement in
public health is more likely to require
a fit for purpose rather than a
one-sizefits-all approach. Um, so we
were keen to not conclude and say only
one type of community engagement seems
to work because different types of
community engagement seem to work better
for different populations and in
different contexts. Um so we have to be
creative and and reflexive I think uh
when when considering what type of
community engagement to use in in applied
applied
settings. And uh we concluded that it's
important to consult with comm community
communities to determine whether and how
they want to be engaged in public health
activities. We shouldn't just um impose
our our structures on them, I suppose.
So, I'd like to um finish off here and
acknowledge uh the co-authors of the
report. Uh we all put in a lot of hard
work to this and I hope it's been useful
for you. Please do have a look at the
final report if you are excited by this
in any way, shape or form. And um you
can contact myself or Jenny um and we'd
be happy to talk further about this. I'm
sorry we only have 10 minutes for
discussion now, but we can open up to discussion.
discussion.
Thank you very much, Allison and Jenny.
That was a a great review. Um, and I
know that was a very uh comprehensive
and exhaustive review. So, it was great
to hear what you you could share in our
limited time today. And the way that you
discussed the results was really great.
I'm sure you're leaving participants
with the skills to go back to the review
uh should they be interested in looking
at other uh outcomes or components uh
that they can find in the
review. So, I'm just going to I'll pass
the ball back to myself
um to go through the remainder of the
presentation. We have a few more polling
questions for our participants and uh in
the meantime, so we'll open up polling
question number four. So, the
information presented to you, if you can
just provide um us with a little bit of
feedback would be great. And in the
meantime, Allison and Jenny, I'm going
to read out some of the questions that
we've had posted so far. And I invite
all participants to continue to post any
questions in the chat or Q&A box. So
starting first uh we have a question
from Mark Andrew who's asking if you can
please clarify the difference between
community engagement and community mobilization.
Yeah. Um it's Jenny here. Um I think we
we conceptualize one of the things we
found when we started looking was that
community engagement uh is a term that's
uh ex used interchangeably with lots of
other terms like community development,
community mobilization, empowerment
strategies and these are all um based on
different theories uh as I say of
different thinking about why you engage
a community in the first place. So
community mobilization I guess is one
aspect of community engagement.
Community engagement we we
conceptualized as a broader term that
encompassed a lot of these other
terms. Does that help?
That's great. Thanks Jenny. And uh we'll
see if we get any feedback from Mark
Andrew about that response but that's
great. I think that's helpful. We have
another question from Le who's asking if
you will be publishing your conceptual
framework for community engagement in interventions.
interventions.
Funny you should mention that. Um I just
submitted it uh to health expectations
actually last week and we're waiting to
hear. So hopefully uh uh again a more
digestible version of the conceptual
framework will be available. Um, but
you're you're uh definitely welcome to
to look at the full report to try and
get your head around and I'm happy to
answer any questions about it. It was a
labor of love.
I can absolutely imagine. That's really
great to hear and uh definitely a lot of
work that certainly a large audience
will be appreciating.
And uh our next question comes from
Carrie who's asking if uh maybe you
mentioned this or if you could clarify
or define what lay delivered
means. So these are interventions in
which a member of the community that
doesn't have any particular um formal
training in health care um when they're
actually involved in delivering the
intervention. So the classic example of
this is the one um I gave an example in
the presentation about um peer
counselors for breastfeeding mothers. So
someone that's just been through the
experience of breastfeeding themselves
going out and helping another mother
establish breastfeeding with her child.
So it's it's about non-expert in the
sense of formal training. Obviously they
have their own expertise because they've
lived the experience. Um but yeah, the
the formal lack of formal training
aspect is the key to that one. And that
they're delivering the intervention, not
just designing or planning the intervention.
That's great. Thanks very much. That's
very helpful. And uh in the meantime,
I'm just going to open up our our last
polling question, which is a uh select
all that apply, which you can review as
you continue uh to submit your questions.
questions.
Uh so next uh we have a question from
Fatima who's asking Allison if you can
explain targeted interventions. You said
interventions for disadvantaged
population was beneficial. What type of
interventions were successful for these populations?
populations?
So the first part of the question about
targeted interventions, uh these are
ones where participants were chosen for
inclusion in a in the intervention on
the basis of a a health need. Um so for
example, mothers that were struggling to
establish breastfeeding. I'll just keep
using that example because I've already
introduced it now, but obviously the
whole report was not just about
breastfeeding. Um, so if if a mother was
identified as having trouble
establishing breastfeeding, then she
would have had an identified health need
and would be targeted for receiving a specific
specific
intervention. In comparison to a
universal intervention where a
breastfeeding counselor might have been
assigned to every mother uh in the
hospital directly after labor,
regardless of whether she was having
trouble establishing breastfeeding or
not. So, it's kind of going to anyone.
um whether they they they have some kind
of need uh in that respect or not. Does
that example clarify or I can give you
that's great. I think that's a great
explanation. We'll hear back from Fatima
if she has any any follow-up questions,
but that's great. Thank you. And we have
another question.
Oh, go ahead. So I was just going to say
there was a second part to the question
about um disadvantage um interventions
being beneficial for people with
disadvantage. So all of the studies that
we included in the review and that was
one of our inclusion criteria was that
they had to have some kind of identified
um disadvantage as specified by the
primary study authors. So we didn't
impose on the on the studies themselves
what we considered to be disadvantage.
The primary study authors had to make a
case for why they felt um the population
that they were uh dealing with that they
they had some type of disadvantage. I
don't know if that clarifies that part
of the question or not. Oh, that's
great. That's great. Thank you. Thank
you, Alison.
Uh we have another question from Daniel
who's asking given the low health
research literacy level among
communities of color and vulnerable
populations do you have data on
approaches to increase knowledge and
skills of communities for community
engaged research and what about specific
training of researchers?
That's actually a really good question
and uh one of our colleagues um her name
is Janet Harris H A R R I S she received
and her colleagues uh received funding
from the NIHR through the same um
program that we did at the same time. So
it was commissioned concurrently
specifically looking at health literacy.
Um, so although I don't feel the best
person placed to to respond to that
myself, um, Janet Harris has published a
report on this. Yeah. And she is that
Sheffield. Sheffield. Sheffield. Yeah.
Yeah. I really encourage you to look at
that that work. It was uh it was
landmark. Yeah. It's a really nice piece
of work. So if you Google Janet Harris
Sheffield health literacy, you she has a
whole program of work, but she's done a
systematic review similar to to ours,
That's great. Thank you very much. We'll
see if we can uh maybe get that link
posted during our session. Very helpful.
Uh so and next we have a a question from
Michelle who's asking if you found any
literature regarding the effectiveness
strategies. Interesting. Um we when we
were extracting information from the
studies, we extracted information about
the engagees. So they're the members of
the community that were engaged to
design or deliver the intervention. And
we also extracted information about the
participants in the so those that were
receiving the intervention. Now we had
quite a number of studies were targeted
at um or or their population of interest
were children. Um so they were the
participants in the intervention but I
don't think we actually picked up any
studies in which children were the
engagees. So the people that were
engaged to design and deliver the
intervention um that might require I
mean we didn't exclude studies on that
basis we just didn't find any that might
require some targeted searching to
specifically pick up uh interventions where children were engaged. Am I Jeie
where children were engaged. Am I Jeie might be able to refresh my memory if
might be able to refresh my memory if I've missed but I don't. No I don't
I've missed but I don't. No I don't think so. Oh actually I just remembered
think so. Oh actually I just remembered the um sexual health ones. There were
the um sexual health ones. There were some of the interventions in the sexual
some of the interventions in the sexual health topic, they had school students
health topic, they had school students do um PER peer sexual health um
do um PER peer sexual health um mediation and things like that. Yeah.
mediation and things like that. Yeah. Yeah. So I to be honest like I can't
Yeah. So I to be honest like I can't remember the specifics of the
remember the specifics of the intervention but that was one area where
intervention but that was one area where there were children involved in
there were children involved in delivering the intervention. Um yeah
delivering the intervention. Um yeah sexual health definitely. So if you're
sexual health definitely. So if you're interested in that, that might be an
interested in that, that might be an area to look into sexual health in
area to look into sexual health in schools in school settings.
schools in school settings. That's great. Thank you very much. And
That's great. Thank you very much. And maybe we'll see more of that research
maybe we'll see more of that research coming out um in the future as
coming out um in the future as well. And so we have maybe time for one
well. And so we have maybe time for one more question um if that's okay with
more question um if that's okay with you, Allison, and and Jenny. We have
you, Allison, and and Jenny. We have quite a few questions from participants,
quite a few questions from participants, which is great. So maybe we can get some
which is great. So maybe we can get some of them to email those to you so we're
of them to email those to you so we're not going too much over time. Um, but we
not going too much over time. Um, but we do have one more question from Hamilton
do have one more question from Hamilton Public Health who's asking if you
Public Health who's asking if you encountered the term targeted
encountered the term targeted universalism in your work and how would
universalism in your work and how would that term fit with your findings about
that term fit with your findings about universal versus targeted approaches?
Hello Hamilton Public Health. That's my old stomping grounds. Nice to see you're
old stomping grounds. Nice to see you're zoomed in from there.
zoomed in from there. Right. Targeted targeted universalism.
We're just trying to think back. We we encountered a lot of many different
encountered a lot of many different terms, but I'm targeted universalism
terms, but I'm targeted universalism isn't one that's jumping straight to
isn't one that's jumping straight to mine. That sounds like that sounds like
mine. That sounds like that sounds like something that I was reading um that
something that I was reading um that Michael Marmet's group talked about. Um
Michael Marmet's group talked about. Um gaps and gradients. Yeah. when you're
gaps and gradients. Yeah. when you're sort of you're talking about, you know,
sort of you're talking about, you know, targeting an intervention to an entire
targeting an intervention to an entire population, but you're hoping to shift
population, but you're hoping to shift the health status while you're hoping to
the health status while you're hoping to shift the health status of everybody in
shift the health status of everybody in that group. You're you're hoping to make
that group. You're you're hoping to make particular gains amongst um groups that
particular gains amongst um groups that are at disadvantage. So, they're they
are at disadvantage. So, they're they would be expected to make greater gains
would be expected to make greater gains uh in relation to the whole
uh in relation to the whole population. Um but I I don't know if
population. Um but I I don't know if that answers the question or not, but
that answers the question or not, but that's Uh that's certainly a phrase I
that's Uh that's certainly a phrase I have seen.
have seen. It's not something
It's not something we analyze in in the review. Um so if if
we analyze in in the review. Um so if if there were I I don't remember coming
there were I I don't remember coming across studies that were would fit under
across studies that were would fit under that definition as as just described it.
that definition as as just described it. Um it was very much an either or
Um it was very much an either or universal or targeted. But it's possibly
universal or targeted. But it's possibly the case that you could ah there
the case that you could ah there proportionate universalism. Yeah. Yeah,
proportionate universalism. Yeah. Yeah, that's the term I've come across more.
that's the term I've come across more. Yep. I don't know if they've seen a
Yep. I don't know if they've seen a name. There was very few instances where
name. There was very few instances where they did measure it in both ways, you
they did measure it in both ways, you know, to to we were hoping we might be
know, to to we were hoping we might be able to say something more about gaps
able to say something more about gaps and gradients analyses, but but they
and gradients analyses, but but they they just weren't there. If you're
they just weren't there. If you're interested in the health inequality side
interested in the health inequality side of things, the the Marmmet review is is
of things, the the Marmmet review is is very useful to read um because there's a
very useful to read um because there's a lot of discussion about gaps and
lot of discussion about gaps and gradients and and proportionate
gradients and and proportionate universalism and um debate about what's
universalism and um debate about what's an appropriate approach. Um yeah. Yeah,
an appropriate approach. Um yeah. Yeah, it's an interesting area. Yeah.
it's an interesting area. Yeah. Unfortunately, our review doesn't really
Unfortunately, our review doesn't really talk to couldn't talk to that because we
talk to couldn't talk to that because we didn't pick up on it in the literature.
That's great. Thanks very much. And we're happy to see that you caught that
we're happy to see that you caught that extra that extra comment as well. So,
extra that extra comment as well. So, we're just starting to go over time and
we're just starting to go over time and we have about three questions left. So,
we have about three questions left. So, Jenny and Allison, would you prefer
Jenny and Allison, would you prefer those questions to be emailed to you
those questions to be emailed to you after the
after the presentation or if you have some time,
presentation or if you have some time, we're happy to read out those questions
we're happy to read out those questions to you now as well. Uh, we can keep
to you now as well. Uh, we can keep going for as long as there's not like a
going for as long as there's not like a thousand more if there are. For sure. We
thousand more if there are. For sure. We have about uh three more. So uh one more
have about uh three more. So uh one more question from Kathy who's asking if you
question from Kathy who's asking if you can comment on the alignment of your
can comment on the alignment of your theories of change with IAP2 spectrum.
Well the short answer is no because I don't know what those are. Okay.
don't know what those are. Okay. Perfect. Maybe we can have uh Kathy
Perfect. Maybe we can have uh Kathy connect with you on on that spectrum.
connect with you on on that spectrum. Yeah, sure. That would be great. Thank
Yeah, sure. That would be great. Thank you. Thanks. And then just one more from
you. Thanks. And then just one more from Anna who's asking if you can discuss
Anna who's asking if you can discuss your findings a fit for purpose in light
your findings a fit for purpose in light of uh universal proportionalism. So kind
of uh universal proportionalism. So kind of bringing back to that same question
of bringing back to that same question as well again.
as well again. So what we found is that um so we
So what we found is that um so we covered a whole range of different
covered a whole range of different interventions as you might be picking up
interventions as you might be picking up from quite personalized ones like the
from quite personalized ones like the the breastfeeding support through to
the breastfeeding support through to ones that were um quite on a much
ones that were um quite on a much broader scale. So for example, there
broader scale. So for example, there were some interventions where
were some interventions where um uh in a particular community, parents
um uh in a particular community, parents were concerned about the lack of
were concerned about the lack of immunization in their community. And so
immunization in their community. And so the parents in that area actually
the parents in that area actually initiated their own public health um
initiated their own public health um intervention to encourage other parents
intervention to encourage other parents to get their kids immunized. So trying
to get their kids immunized. So trying to to break down some of the the myths
to to break down some of the the myths around childhood immunization basically
around childhood immunization basically but coming from the parents. Now the the
but coming from the parents. Now the the range of of different ways of engaging
range of of different ways of engaging the community we saw like they're two
the community we saw like they're two examples opposite ends of the spectrum
examples opposite ends of the spectrum but there was pretty much anything in
but there was pretty much anything in between and we think different um
between and we think different um approaches are going to make sense for
approaches are going to make sense for different health problems. So having a
different health problems. So having a peer counseling situation for childhood
peer counseling situation for childhood immuniz immunization doesn't make sense.
immuniz immunization doesn't make sense. Whereas having a a parent
Whereas having a a parent um promotion activity where they go out
um promotion activity where they go out and encourage and break down the myths
and encourage and break down the myths of of um childhood immunization makes
of of um childhood immunization makes much more sense. um it it it basically
much more sense. um it it it basically you need to adapt the approach to the
you need to adapt the approach to the particular health problem and what the
particular health problem and what the what this what makes sense for that
what this what makes sense for that situation I guess. Yeah. And I think
situation I guess. Yeah. And I think some of that goes back to the conceptual
some of that goes back to the conceptual framework when you're thinking about the
framework when you're thinking about the needs. Um it's who's identifying that
needs. Um it's who's identifying that there's a health need to start with you
there's a health need to start with you know is it sort of a a government uh
know is it sort of a a government uh body who's saying you know there this is
body who's saying you know there this is a real issue and we need to do something
a real issue and we need to do something about it or is it you know as in the
about it or is it you know as in the case that Allison provided where parents
case that Allison provided where parents are saying actually this is a problem
are saying actually this is a problem because you know our kids are getting
because you know our kids are getting ill because other kids aren't immunized.
ill because other kids aren't immunized. Um so that that sort of thinking through
Um so that that sort of thinking through the issues around why you might want to
the issues around why you might want to undertake a community engagement
undertake a community engagement strategy um and for what purpose is is
strategy um and for what purpose is is important and it's it's worth taking
important and it's it's worth taking into consideration before you even get
into consideration before you even get something up and running.
That's really great and really uh important notes that you've made there.
important notes that you've made there. Uh thanks for that response. And we just
Uh thanks for that response. And we just have one last question from uh Marcus
have one last question from uh Marcus who's asking uh maybe if you can provide
who's asking uh maybe if you can provide one or two overall suggestions that you
one or two overall suggestions that you would have for additional research in
would have for additional research in this area based on your findings from
this area based on your findings from the review.
the review. Um so we made a few recommendations in
Um so we made a few recommendations in the report itself. um picking out which
the report itself. um picking out which ones to so there's practice implications
ones to so there's practice implications or research but in terms of research one
or research but in terms of research one of the things that we noticed was that
of the things that we noticed was that not all of the studies
not all of the studies um measured a range of different
um measured a range of different outcomes and we saw different benefits
outcomes and we saw different benefits of different interventions on different
of different interventions on different outcomes. So if you only measure one or
outcomes. So if you only measure one or two outcomes, so if you only focus on
two outcomes, so if you only focus on health uh consequences like diagnosis or
health uh consequences like diagnosis or mortality for example, you might miss
mortality for example, you might miss some of those step changes in health
some of those step changes in health behaviors or self-efficacy and things
behaviors or self-efficacy and things like that. So one recommendation it
like that. So one recommendation it would be to if you're doing primary
would be to if you're doing primary research in this area you're doing
research in this area you're doing evaluations is to try and measure a
evaluations is to try and measure a broader range of outcomes um to pick up
broader range of outcomes um to pick up on a range of different benefits and in
on a range of different benefits and in particular we thought there was a bit of
particular we thought there was a bit of a deficit around measuring benefits for
a deficit around measuring benefits for the people that were engaged in the
the people that were engaged in the intervention. Um there's some
intervention. Um there's some qualitative literature and and
qualitative literature and and theorizing around the notion of um if
theorizing around the notion of um if you get people engaged and empower them,
you get people engaged and empower them, they then beyond the intervention that
they then beyond the intervention that they're involved in, they become kind of
they're involved in, they become kind of health ambassadors and they improve
health ambassadors and they improve their own health but also those around
their own health but also those around them going forward above and beyond what
them going forward above and beyond what they did in the intervention. So, it's
they did in the intervention. So, it's about
about um upskilling and creating a whole new
um upskilling and creating a whole new dynamic self- evvolving community of
dynamic self- evvolving community of people that care about improving health.
people that care about improving health. Um, and some of the interventions that
Um, and some of the interventions that we saw, they they continue on once the
we saw, they they continue on once the funding for the intervention finishes.
funding for the intervention finishes. The members of the community were so
The members of the community were so excited or pleased with the intervention
excited or pleased with the intervention that they found ways and skilled. Yeah.
that they found ways and skilled. Yeah. that they found ways to keep it going
that they found ways to keep it going above beyond the intervention. The
above beyond the intervention. The measuring outcomes for the engaged
measuring outcomes for the engaged people is another thing and linked to my
people is another thing and linked to my very last point about the time frame. So
very last point about the time frame. So that there were benefits in some of
that there were benefits in some of these interventions that we got
these interventions that we got anecdotally and through the process
anecdotally and through the process evaluation that um some of the
evaluation that um some of the interventions kept going beyond the the
interventions kept going beyond the the the intervention lifespan itself. It's
the intervention lifespan itself. It's natural lifespan. They kept it going. So
natural lifespan. They kept it going. So there's a a bit of a need for measuring
there's a a bit of a need for measuring longer term outcomes to see, you know,
longer term outcomes to see, you know, do these do the benefits that we see
do these do the benefits that we see immediately after inter the intervention
immediately after inter the intervention finishes, do they keep rolling on um in
finishes, do they keep rolling on um in the future and have have we really
the future and have have we really instigated lifelong behavior change or
instigated lifelong behavior change or is it just a bit of a halo effect? You
is it just a bit of a halo effect? You know, if the euphoria effect it's
know, if the euphoria effect it's sometimes called that you've had fun in
sometimes called that you've had fun in the intervention but once it all goes
the intervention but once it all goes away.
away. Yeah.
Yeah. Are you have you really fundamentally
Are you have you really fundamentally changed people's
changed people's behaviors? So yeah, they're all around
behaviors? So yeah, they're all around measurement of outcomes, I guess, in
measurement of outcomes, I guess, in terms of my research recommendations. So
terms of my research recommendations. So there there are others, but we can't
there there are others, but we can't give them all away. You have to read the
give them all away. You have to read the report.
report. Now, this is the taster, the teaser.
Now, this is the taster, the teaser. That's really great, Allison. We
That's really great, Allison. We appreciate that, especially from a
appreciate that, especially from a research and a practice standpoint.
research and a practice standpoint. those are interesting and we'll be sure
those are interesting and we'll be sure to check out uh the rest of the
to check out uh the rest of the recommendations that you have in the
recommendations that you have in the report uh as well. So, we'll leave it
report uh as well. So, we'll leave it there for for today and thank you so
there for for today and thank you so much for taking the time to respond to
much for taking the time to respond to all those questions. We had so much um
all those questions. We had so much um participant engagement and user interest
participant engagement and user interest in this review and this webinar in
in this review and this webinar in particular. So, we're very very excited
particular. So, we're very very excited and pleased to have you present. Uh for
and pleased to have you present. Uh for those who are still with us in the
those who are still with us in the session, please note that a copy of the
session, please note that a copy of the presentation will be made available on
presentation will be made available on health evidence and we'll provide the
health evidence and we'll provide the links uh to those resources in the chat
links uh to those resources in the chat section. So I'll leave it to you Allison
section. So I'll leave it to you Allison and Jenny if you have any uh just final
and Jenny if you have any uh just final small words for our audience before we
small words for our audience before we close for the day.
close for the day. Uh I'd like to thank everybody for
Uh I'd like to thank everybody for taking the time today to have a listen
taking the time today to have a listen and for your excellent questions. It was
and for your excellent questions. It was really nice for us, I think, to uh sit
really nice for us, I think, to uh sit and think about community engagement
and think about community engagement again. It's one of our our favorite
again. It's one of our our favorite topics. Yeah. So, so thank you for this
topics. Yeah. So, so thank you for this review. Yeah, it was it was hard, but it
review. Yeah, it was it was hard, but it was good fun.
was good fun. Absolutely. Absolutely. Very
Absolutely. Absolutely. Very appreciated.
appreciated. Yeah, we thank you health evidence for
Yeah, we thank you health evidence for uh for organizing this. as I said is
uh for organizing this. as I said is that we like opportunities to be able to
that we like opportunities to be able to communicate the findings um on a bit
communicate the findings um on a bit more manageable scale because uh we want
more manageable scale because uh we want this to be useful for people and it
this to be useful for people and it breaks our heart a little bit that
breaks our heart a little bit that people might be turned off by the 548
people might be turned off by the 548 page report. So uh please bear with us
page report. So uh please bear with us and and do ask questions if you if you
and and do ask questions if you if you have
have um you there's more specific information
um you there's more specific information you'd like. We're happy to hear from
you'd like. We're happy to hear from people. Yeah, for sure. That's really
people. Yeah, for sure. That's really great. And Again, like I said, very
great. And Again, like I said, very comprehensive and extensive review. We
comprehensive and extensive review. We definitely appreciate all of the work
definitely appreciate all of the work that goes into that. Um, yeah, that
that goes into that. Um, yeah, that cannot be overlooked. So, that's really
cannot be overlooked. So, that's really great. Thank you very much for
great. Thank you very much for presenting with us today and all of
presenting with us today and all of those who have uh stayed throughout the
those who have uh stayed throughout the session and asked great questions. With
session and asked great questions. With that, we close off our session today.
that, we close off our session today. So, thank you everyone for joining us
So, thank you everyone for joining us and have a great
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