Research Article: Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes

Date Published: May 10, 2019

Publisher: Public Library of Science

Author(s): Victoria Haldane, Fiona L. H. Chuah, Aastha Srivastava, Shweta R. Singh, Gerald C. H. Koh, Chia Kee Seng, Helena Legido-Quigley, Cathy Maulsby.


Community participation is widely believed to be beneficial to the development, implementation and evaluation of health services. However, many challenges to successful and sustainable community involvement remain. Importantly, there is little evidence on the effect of community participation in terms of outcomes at both the community and individual level. Our systematic review seeks to examine the evidence on outcomes of community participation in high and upper-middle income countries.

This review was developed according to PRISMA guidelines. Eligible studies included those that involved the community, service users, consumers, households, patients, public and their representatives in the development, implementation, and evaluation of health services, policy or interventions. We searched the following databases from January 2000 to September 2016: Medline, Embase, Global Health, Scopus, and LILACs. We independently screened articles for inclusion, conducted data extraction, and assessed studies for risk of bias. No language restrictions were made. 27,232 records were identified, with 23,468 after removal of duplicates. Following titles and abstracts screening, 49 met the inclusion criteria for this review. A narrative synthesis of the findings was conducted. Outcomes were categorised as process outcomes, community outcomes, health outcomes, empowerment and stakeholder perspectives. Our review reports a breadth of evidence that community involvement has a positive impact on health, particularly when substantiated by strong organisational and community processes. This is in line with the notion that participatory approaches and positive outcomes including community empowerment and health improvements do not occur in a linear progression, but instead consists of complex processes influenced by an array of social and cultural factors.

This review adds to the evidence base supporting the effectiveness of community participation in yielding positive outcomes at the organizational, community and individual level.

Prospero record number:CRD42016048244.

Partial Text

Community participation came to the fore with the 1978 Alma Ata declaration, which framed the community as central to the planning, organizing, operation and control of primary health care [1]. In recent years, community participation has once again emerged as a priority in health globally following the initiation of the new Sustainable Development Goals. In line with the SDGs, integrated people-centered health services are key to achieving universal health coverage and attaining this goal requires participatory approaches [2]. Furthermore, with the rapid increase of chronic disease burden worldwide, intersectoral approaches encompassing community participation and engagement has been identified as key for implementing strategies in health promotion and the prevention and control of chronic diseases [3].

This review was developed according to PRISMA guidelines (see S1 Table) [11] and submitted to Prospero at study initiation under record number CRD42016048244. Drawing on the definitions by George et al. (2015)[12], the concept of community and community participation is described in Box 1.

27,232 records were identified through database searching. 23,468 articles were screened by title followed by 1,740 abstracts screened for inclusion. The full text of 707 articles was obtained and assessed for eligibility. After screening for reported objectives, 49 articles met eligibility criteria for this review (Fig 1). Due to the heterogeneity in study design, intervention types, participants, and outcomes, we conducted a narrative synthesis of the findings instead of a meta-analysis.

This review explores reported outcomes of community involvement and participation and presents a conceptual model to frame these outcomes, beginning with a foundation of process outcomes and community outcomes as necessary to achieving robust health outcomes, while recognizing the influence of stakeholder perspectives and empowerment.




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