Health Evidence hosted a 60 minute webinar examining the effectiveness of community engagement in public health interventions for disadvantaged groups. Click here for access to the audio recording for this webinar: https://youtu.be/tUZ-u7QbMCY. Alison O'Mara-Eves, Senior Researcher, University College London, EPPI-Centre and Ginny Brunton, Senior Health Researcher, University College London, EPPI-Centre presented findings from their review: O'Mara-Eves A., Brunton G., Oliver S., Kavanagh J., Jamal F., & Thomas J. (2015). The effectiveness of community engagement in public health interventions for disadvantaged groups: A meta-analysis . BMC Public Health, 15, 129. Community engagement is becoming an increasingly popular component included in the development and implementation of public health interventions. Involved community members take on roles that range from merely being informed, to being consulted, to collaborating or leading on the design, delivery and evaluation of public health strategies. This review examines the use of public health interventions with a community engagement component, particularly for its use in reducing health inequities among disadvantaged populations. Findings of the review suggest community engagement in public health interventions has an effect on several health outcomes, including health behaviours and self-efficacy. This webinar will examine the effectiveness and components of public health interventions that include community engagement and the impact on health outcomes.

1. Welcome!
Community engagement in
public health interventions
for disadvantaged groups:
What's the evidence?
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3

4. What’s the evidence?
O’Mara-Eves A., Brunton G., Oliver S.,
Kavanagh J., Jamal F., & Thomas J. (2015).
The effectiveness of community engagement
in public health interventions for
disadvanted groups: A meta-analysis. BMC
Public Health, 15, 129.
http://healthevidence.org/view-
article.aspx?a=effectiveness-community-engagement-
public-health-interventions-disadvantaged-29020

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11. A Model for Evidence-
Informed Decision Making
National Collaborating Centre for Methods and Tools. (revised 2012). A
Model for Evidence-Informed Decision-Making in Public Health (Fact
Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]

12. Stages in the process of
Evidence-Informed Public Health
National Collaborating Centre for Methods and Tools. Evidence-Informe
Public Health. [http://www.nccmt.ca/eiph/index-eng.html]

13. Poll Question #2
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14. Searchable Questions Think “PICOS”
1. Population (situation)
2. Intervention (exposure)
3. Comparison (other group)
4. Outcomes
5. Setting

15. How often do you use Systematic Reviews
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E.I don’t know what a systematic review is
Poll Question #3

16. Alison O’Mara-Eves
Senior Research
Officer, University
College London,
Institute of Education,
EPPI-Centre
Ginny Brunton
Senior Health
Researcher, University
College London,
Institute of Education,
EPPI-Centre

17. Do public health interventions
that engage the community
improve health-related outcomes
for disadvantaged groups?
Systematic review and meta-analysis
Alison O’Mara-Eves and Ginny Brunton
EPPI-Centre
Social Science Research Unit
Department of Social Science
UCL Institute of Education
University College London
HealthEvidence.ca Webinar
21st October 2016

18. • This project was funded by the UK National
Institute for Health Research (NIHR). The views
and opinions expressed by authors in this
presentation are those of the authors and do not
necessarily reflect those of the NIHR.
• Project conducted by a team of researchers at
the UCL Institute of Education, London School of
Economics, and University of East London.
• All authors declared no conflicts of interest.
Funding and conflicts of interest

19. O'Mara-Eves A, Brunton G,
McDaid D, Oliver S,
Kavanagh J, Jamal F, et
al.
Community engagement
to reduce inequalities in
health: a systematic
review, meta-analysis and
economic analysis.
Public Health Research
2013;1(4).
The 548 page report

20. 1. The research topic

21. What is community engagement?
• Community engagement defined here as a:
– direct or indirect process of involving communities in
decision-making and/or in the planning, design,
governance and delivery of services,
– using methods of consultation, collaboration, and/or
community control.
• Takes many forms. Examples:
service user networks healthcare forums
volunteering courses delivered by trained peers
interactive websites for views and
opinions via surveys
public consultations
community coalitions

22. Health inequalities
• Socially determined differences in health
outcomes
• Causes are modifiable (e.g., socioeconomic
status, social exclusion) rather than biological
(e.g., genetic predisposition)
• Marmot Review of health inequalities in
England, ‘Fair Society, Healthy Lives’ (2010)
identified four key modifiable health risks:
– Smoking
– Alcohol abuse
– Substance abuse
– Obesity

23. Health inequalities: priority areas
Marmot Review also identified six policy
objectives:
1. giving children the best start in life,
2. enabling all children, young people and adults to
maximise their capabilities,
3. creating fair employment and good work for all,
4. ensuring a healthy standard of living for all,
5. developing healthy and sustainable places and
communities, and
6. strengthening the role and impact of health
prevention.

24. Community engagement and health
inequalities
• Community engagement is arguably
particularly suited for disadvantaged and
socially excluded groups
• It is proposed that community engagement:
– encourages social justice and can “give a voice
to the voiceless”
– can produce interventions that better meet
community needs (cultural competence; more
empathic approaches)

25. 2. The broader project

26. • Patchwork of theories and conceptual
frameworks
• Unclear empirical evidence about
effectiveness and cost-effectiveness
• Much uncertainty about processes
The research problem

27. Sensitive searches
for systematic
reviews
Identified primary
studies within
reviews
Extracted data on
key concepts and
characteristics
Map of
interventions
Selected
interventions
targeting Marmot
priority areas for in-
depth review
Extracted
effectiveness data;
assessed risk of bias
Conducted
syntheses
Overview of process

28. In-depth review syntheses
1. Effectiveness
2. Processes
3. Economic
4. Theoretical

29. Sensitive searches
for systematic
reviews
Identified primary
studies within
reviews
Extracted data on
key concepts and
characteristics
Map of
interventions
(n = 361)
Selected
interventions
targeting Marmot
priority areas for in-
depth review
Extracted
effectiveness data;
assessed risk of bias
Results of:
Theory synthesis
Meta-analysis
Presentation coverage

30. 3. Theory synthesis

31. Theory Synthesis Methods
• Many theories about why CE is important and
how it might work (or not!)
• We extracted data from included studies
– Key discussion pieces (‘background’ articles)
– Exemplar process evaluations
• We then grouped data and iteratively
developed themes
Discussion Pieces/Process Data Advisory Group Input
Conceptual Framework
Trials Data

32. Community Engagement in Interventions: Conceptual Framework

33. 1. Empowerment: change is facilitated where the health
need is identified by the community and they mobilise
themselves into action
2. Collaboration or…
3. …consultation in intervention design: the views of
stakeholders are sought with the belief that the
intervention will be more appropriate to the
participants’ needs as a result
4. Lay-delivery: change is believed to be facilitated by
the credibility, expertise, or empathy that the
community member can bring to the delivery of the
intervention
Theories of change identified
in the theoretical synthesis

34. 4. Meta-analysis
• Journal article: 23 pages

35. Results: Effectiveness studies (N = 131)
Countries
– 4% (n = 5) UK
– 86% (n = 113) USA
– 4% (n = 5) Canada
– 6% (n = 8) other OECD
Population/Health inequalities
– 43% (n = 56) ethnic minorities
– 26% (n = 34) low socioeconomic position
– 16% (n = 21) multiple health inequalities

36. Results: Health topic
0
2
4
6
8
10
12
14
16
18
18
14
13 13
12
8
7
6 6 6
5 5
4 4
3
2 2
1 1 1
Health Topics (N=131 studies)

37. Results: Outcome types
• Health behaviours (n=105)
e.g. breastfeeding, attend
cancer screening
• Health consequences
(n=38)
e.g. mortality, diagnosis
• Participant self-efficacy
(n=20)
• Participant social support
(n=7)
• Also a small number of
community outcomes and
‘engagee’ outcomes – not
meta-analysed

38. Results: Overall mean effects
*** p < .001
Statistical significance indicates the effect size estimate is significantly different from zero
Note. 95% CI = 95% confidence interval
n = number of effect sizes
τ2 = between studies variance
Heterogeneity
Outcome Pooled
effect size
estimate
95% C.I. n τ2 Q statistic I2
Health behaviours .33*** .26, .40 105 .093 604.62*** 82.80
Health consequences .16** .06, .27 38 .076 196.36*** 81.16
Participant self-efficacy .41** .16, .65 20 .278 480.44*** 96.05
Participant social
support
.44*** .23, .65 7 .067 42.67*** 85.94
In general, interventions
are effective
Variation amongst
studies needs to be
explained

39. • Conducted moderator and regression analyses
• Most of the analyses conducted on health
behaviour outcomes only because of small
number of data points
Attempts to explain variation

40. Moderator of effect on health
behaviours: Theory of change

41. Other moderators tested
• Single component interventions tended to be
more effective at improving health behaviours
than multiple component interventions
• Universal interventions tended to have higher
effect size estimates for health behaviour
outcomes than targeted interventions
• Interventions conducted in non-community settings
tended to be more effective than those in community
settings for health behaviour outcomes

42. Features of the interventions
• Interventions that employed skill development or training strategies,
or which offered contingent incentives, tended to be more effective
than those employing educational strategies for health behaviour
outcomes
• Interventions involving peers, community members, or education
professionals tended to be more effective than those involving health
professionals for health behaviour outcomes
• Shorter interventions tended to be more effective than longer
interventions for health behaviour outcomes; this is probably
confounded by levels of exposure or intensity of contact with the
intervention deliverer

43. Participant characteristics
• Interventions tended to
be most effective in
adult populations and
less effective in general
population interventions
for health behaviour
outcomes
• Interventions tended to
be most effective for
health behaviour
outcomes for
participants classified as
disadvantaged due to
socioeconomic position

44. 5. Conclusions

45. Conclusions
• Overall, public health interventions using
community engagement strategies for
disadvantaged groups are effective in terms of
health behaviours, health consequences,
participant self-efficacy, and participant
perceived social support
• These findings appear to be not due to
systematic methodological biases

46. Conclusions
• However, there is still unexplained variation
amongst the effect sizes
• “…the evidence suggests that community
engagement in public health is more likely to
require a ‘fit for purpose’ rather than ‘one size
fits all’ approach.”
• Consult with communities to determine
whether and how they want to be engaged in
public health activities

47. • Co-authors:
– David McDaid
– Sandy Oliver
– Josephine Kavanagh
– Farah Jamal
– Tihana Matosevic
– Angela Harden
– James Thomas
• Authors of and participants in the reviewed
studies
Acknowledgements
EPPI-Centre
Department of Social Science
UCL Institute of Education
University College London
18 Woburn Square
London WC1H 0NR
Tel +44 (0)20 7612 6397
Fax +44 (0)20 7612 6400
Email eppi@ioe.ac.uk
Web eppi.ioe.ac.uk/
The final report is available to download at
http://www.journalslibrary.nihr.ac.uk/phr/volume-1/issue-4
Further details a.o’mara-eves@ucl.ac.uk

48. A Model for Evidence-
Informed Decision Making
National Collaborating Centre for Methods and Tools. (revised 2012). A
Model for Evidence-Informed Decision-Making in Public Health (Fact
Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]

49. Poll Question #4
The information presented today was
helpful
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree

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