Participation by conflict-affected and forcibly displaced communities in humanitarian healthcare responses: A systematic review.
Participation by conflict-affected and forcibly displaced communities in humanitarian healthcare responses: A systematic review.
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DOI：
10.1016/j.jmh.2020.100026
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发表时间：
2020
影响因子：
4.6
通讯作者：
Roberts B
中科院分区：
文献类型：
--
作者：
Rass E;Lokot M;Brown FL;Fuhr DC;Asmar MK;Smith J;McKee M;Orm IB;Yeretzian JS;Roberts B
证据的数量和质量适中，表明社区参与有好处。关于社区参与确定问题或设计解决办法的证据有限。对社区参与和权力关系的建设参与不足。关于被迫流离失所社区参与的证据极其薄弱。人道主义行为体越来越多地推动社区参与人道主义危机中的卫生应对工作，以支持采取与当地需求相关和有效的措施。我们的目的是了解社区参与对低收入和中等收入国家受冲突影响的人口（包括被迫流离失所的人口）的人道主义卫生反应的作用，以及社区参与医疗保健反应的障碍和促进因素。使用系统评价方法，遵循PRISMA协议，我们检索了四个书目数据库，以获得报告同行评议的主要研究的出版物。如果研究报告了受冲突影响的人口如何参与低收入和中等收入环境中的医疗保健应对措施，以及医疗保健应对措施或健康结果的相关变化，则选择这些研究。我们采用描述性专题综合和评估研究质量使用研究设计特定的评价工具。在通过数据库检索确定的18，247条记录中，18项研究符合我们的纳入标准。观察到各种类型的社区参与，参与主要涉及执行干预措施，而不是提出问题或设计解决办法。大多数关于社区参与的研究侧重于保健服务的变化（获得、利用、质量）、社区的接受程度和认识以及所有权和可持续性。社区参与的主要障碍和促进因素包括国家和地方一级的政治意愿、持续的武装冲突、财政和经济因素、社区的社会文化动态、人道主义反应的设计、卫生系统因素以及卫生知识和信念。纳入的研究质量参差不齐，证据的总体强度较弱。更一般地说，对参与概念的批判性参与有限。本次审查强调，需要更多的研究更有意义的社区参与在受冲突影响的社区的医疗保健反应，特别是在制定问题和创造解决方案。还需要进行更有力的研究，将社区参与与长期的个人和卫生系统成果联系起来，并严格参与社区参与的结构。
The moderate quantity and quality of evidence indicate benefits from community participation. There was limited evidence on involvement of communities in framing problems or designing solutions. There was inadequate engagement with the construct of community participation and power relations. There was extremely weak evidence on participation by forcibly displaced communities. Community participation in health responses in humanitarian crises is increasingly promoted by humanitarian actors to support adoption of measures that are relevant and effective to local needs. Our aim was to understand the role of community participation in humanitarian health responses for conflict-affected populations (including forcibly displaced populations) in low- and middle-income countries and the barriers and facilitators to community participation in healthcare responses. Using a systematic review methodology, following the PRISMA protocol, we searched four bibliographic databases for publications reporting peer-reviewed primary research. Studies were selected if they reported how conflict-affected populations were involved in healthcare responses in low- and middle-income settings, and associated changes in healthcare responses or health outcomes. We applied descriptive thematic synthesis and assessed study quality using study design-specific appraisal tools. Of 18,247 records identified through the database searching, 18 studies met our inclusion criteria. Various types of community participation were observed, with participation mostly involved in implementing interventions rather than framing problems or designing solutions. Most studies on community participation focused on changes in health services (access, utilisation, quality), community acceptability and awareness, and ownership and sustainability. Key barriers and facilitators to community participation included political will at national and local level, ongoing armed conflict, financial and economic factors, socio-cultural dynamics of communities, design of humanitarian responses, health system factors, and health knowledge and beliefs. Included studies were of mixed quality and the overall strength of evidence was weak. More generally there was limited critical engagement with concepts of participation. This review highlights the need for more research on more meaningful community participation in healthcare responses in conflict-affected communities, particularly in framing problems and creating solutions. More robust research is also required linking community participation with longer-term individual and health system outcomes, and that critically engages in constructs of community participation.
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影响因子：
3.6
作者：
Adams, Ben;Vallieres, Frederique;Eaton, Julian
通讯作者：
Eaton, Julian
影响因子：
2.7
作者：
Ghebreyesus, TA;Alemayehu, T;Teklehaimanot, A
通讯作者：
Teklehaimanot, A
影响因子：
3.4
作者：
Claude, Kasereka Masumbuko;Hawkes, Michael T.
通讯作者：
Hawkes, Michael T.
影响因子：
8.3
作者：
Fung, Archon
通讯作者：
Fung, Archon
影响因子：
3.6
作者：
Ho, Lara S.;Labrecque, Guillaume;Ratnayake, Ruwan
通讯作者：
Ratnayake, Ruwan