Relational Community Engagement within Health Interventions at Varied Outcome Scales

"The review highlights the potential versatility and effectiveness of interventions that prioritize relationships, health promotion, and social change while underscoring the significance of holistic and community-centered approaches in addressing diverse health and social challenges."

Community engagement is a process aimed at addressing health-related issues, promoting well-being, and acting on the social determinants of health. The approach helps uncover and tackle local issues, implement grassroots solutions, and leverage local resources and networks to sustain health interventions and outcomes. Achieving successful community engagement often requires an understanding of the attributes and nature of human relationships, including trust, resilience, and responsiveness. The purpose of this narrative review is to synthesise the literature on "relational community engagement" within varied health interventions at the three major system levels (micro, meso, and macro) to support the development of future research agendas.

The paper describes relational community engagement as "an approach that conjoins individual and collective awareness, and is intentional about processes that facilitate positive connection, belonging, and communication - all of which are needed for meaningful collaboration and co-production. This approach emphasizes and centers on building nurturing, ongoing, and longstanding relationships between different stakeholders, including community members, organizations, and institutions for improved health outcomes.... Rather than focusing solely on specific projects or outcomes, relational community engagement places a strong emphasis on developing and maintaining long-term connections and trust within communities..."

Table 2 in the paper presents a list of relational community engagement interventions along with their corresponding definitions. Improving accountability and governance as well as promoting social participation are often highlighted as outcomes. Interventions have been focused less commonly on community engagement itself as an outcome (i.e., explicitly recognising its value in health-related initiatives). Mixed intervention methods (i.e., implementing varied combinations of the different intervention types outlined in Table 2) with a comprehensive approach that combines multiple strategies (e.g., improving access to and quality of services) are frequently leveraged within relational community engagement interventions. In addition, relational community engagement interventions often embody multiple categories of interventions (i.e., they are multi-layered, incorporating different levels of interventions).

Next, the paper examines literature on relational community engagement intervention outcomes at micro, meso, and macro levels. In brief:

• At the micro level, relational community engagement has emphasised comprehending and addressing the unique needs and perspectives of individuals within a community. By acknowledging the diverse backgrounds, preferences, and challenges faced by community members, targeted interventions are designed to promote positive health behaviours and tailor support to foster a healthier collective. At the micro level, relational community engagement interventions demonstrated a range of positive outcomes, including: increased sense of control, satisfaction, positive behaviour, improved knowledge, behaviour change, empowerment, and overall positive health and social outcomes.
• At the meso level, the focus of relational community engagement often shifts toward understanding the interconnectivity of various community subgroups. The idea is that, by fostering collaborative partnerships and leveraging existing resources, a more integrated and holistic approach to community health may be achieved. relational community engagement interventions demonstrated a range of positive outcomes, including: increased community awareness of various health issues (e.g., HIV transmission), improved healthcare quality, enhanced community cohesion, strengthened relationships with authorities and service providers, and increased access to services and resources. The success of these interventions emphasises the importance of community involvement and collaboration in addressing various health and social challenges.
• At the macro level, the focus of relational community engagement tends to correspond to the broader societal context. Here, the collective efforts of engaged communities influence public health policies and social determinants of health - ultimately contributing to larger systemic changes. At the macro level, relational community engagement interventions influenced broader societal factors and had positive impacts on health policy and governance, including collaboration between sectors and communities as well as increased access to services. By advocating for equitable access to healthcare, addressing social inequalities, and promoting community-driven initiatives, macro-level relational community engagement has instigated transformative effects on population health and well-being.

Reflecting on this review of community engagement interventions, the researchers suggest that tailoring interventions to the local context and need is "seen to be key to achieving the desired health outcomes, as well as fostering collective action, social support, and sustainable change. When communities actively participate, they become invested in their own health, often leading to the improved outcomes seen in the body of included articles. Promoting social participation stood out as a key element in the literature due to its consistent positive outcomes with individuals and communities engaged in decision-making processes that fostered a sense of ownership, belonging, empowerment, and accountability."

The review also highlights that "trust can be continuously reinforced or broken in the everyday interactions between service providers and service users across all sectors. The quality and experience of these relationships and services impact the quality of health services, service uptake, and overall health outcomes." To that end, the researchers recommend a few research streams to build out relational community engagement at the health system level, such as exploring and further generating empirical evidence for relational community engagement in the context of healthcare quality and health system performance.

In addition, research agendas for relational community engagement should "be underpinned by a social determinants framing, actively embracing complexity, and embodying the developmental nature of human experience. Research efforts should also seek to foreground the social, emotional, and relational processes that remain largely invisible in healthcare practice and medicine as it is practiced today....[Furthermore,] while studies cover various health issues and settings, it is important to consider the cultural and contextual differences that may influence the outcomes of relational community engagement interventions."

In conclusion: "Ultimately, a well-connected, purposeful, and aligned healthcare system characterized by trust, resilience, and responsiveness is essential in the journey toward achieving high-quality primary healthcare and universal health coverage..."