Community engagement in health services research on soil-transmitted helminthiasis in Asia Pacific region: Systematic review

The research question was what studies are available that have assessed community engagement in the health services research on soil-transmitted helminths? We aimed to synthesise evidence on how communities were engaged in health services research on soil-transmitted helminths in low-and-middle-income countries of the Asia-Pacific Region. We focused on this region because soil-transmitted helminths are endemic, and their burden is significant in this region. This review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) checklist. Relevant studies were searched in health-related databases including PubMed, Ovid, and Google Scholar. We selected studies based on the selection criteria set for this review. We collected textual information about the type of health services research, the degree of community engagement, the research phases involved, and the barriers/enablers affecting community engagement in research since they are pertinent to our review question and objective. Ten studies from seven countries in the Asia Pacific region were identified for this review. Albeit with variation in the extent of their involvement, various forms of communities/groups within communities were included such as Aboriginal communities, local communities, school children and their parents, school teachers and headmasters of schools, heads of villages, religious leaders, and so on. Overall, community engagement in health services research focused on of soil-transmitted helminths was limited. Six studies (60%) had collaboration at ‘developing methodology’, mainly through an explanation of the objectives of the study or study process to be conducted. Seven studies (70%) revealed community participation in soil-transmitted helminths at the “data collection” stage. Only one study (10%) documented that a community leader was involved as a co-author, reflecting an involvement in ‘report writing’ and further ‘dissemination’. Findings suggest that there were various forms of community engagement in various aspects of the health services research context. Overall, there was moderate level of participation, but there was insufficient information on the partnership between various stakeholders, which prevented in-depth analysis of the engagement. Future health services research on soil-transmitted helminth interventions needs to be carefully planned, well designed, grounded in principles of community engagement, and designed methodologically to allow in-depth participation by communities in all stages of the research.


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has not fundamental concerns about the study but offers a number of comments to further improve the manuscript: Q/ -Line 78: "people and the act that is the most common cluster"the second part of the sentence is unclear. Consider revising.

Our reply/
For clarity, we have rephased this sentence. Thank you

Line # 81-83
Of these, soil-transmitted helminth infection (STH) represents the most prevalent cluster of NTDs worldwide [5] and receives less attention than would be suggested by the burden it takes on people.
Our reply/

Q/
-Line 141: "Asian" should be "Asia" Communities residing in LMICs in WHO defined Western Pacific and South East Asia, regardless of age and gender. Communities is as defined in the primary studies.

Our reply/
We have corrected it. Thank you

Line #204-207
As an example, study X showed CE as 'consultation' at 'developing ideas', collaboration at 'developing methodology', and 'informed' at data collection/analysis, but 'no information' at reporting writing and 'collaboration' at dissemination stage,) achieved a total score of 2 (i.e., 0+ 1+ 0+0+1= 2). Table 1 and Table 3: check formatthe chosen format is unsuitable for publication due to very long and narrow columns.

Our reply/
We have reformatted Table 1 and Table 2. Thank you

Our reply/
The correct number of studies is ten for this revised version. Thank you.

Line # 310-311
The present review of ten studies from seven LMICs in the Asia Pacific Region revealed minimal/limited CE in the research. Q/-Lines 332-335: the sentence is very long and unclear. Consider revising.

Our reply/
This section has been rephrased by being divided into two sentences. Thank you

In the revised version
Line # 314-317 The majority of the studies that composed this review were designed to report on health outcomes, with no description or evaluation of the level of community involvement in HSR.
This revealed that rather than focusing on the level of CE in HSR, the primary objectives of these primary studies were to investigate health consequences.
Q/-Lines 340-341: the last sentence of the paragraph is unclear. Consider revising.

Our reply/
We have rephrased this part. Thank you

Line # 324-325
Similar to a published review [35], communities are regulated by power relations such as local governments, which participated in community-based interventions [25,32].

Q/
-Discussion: the actual discussion seems to be missing -there is only a "summary of evidence", "study limitations" and "conclusions". A point to discuss is e.g. a comparison of the findings with the situation in other areas of public health, and/or other geographical areas.
Other possible points to discuss include the optimal design of studies in this area, considerations under which circumstances community engagement is especially critical/not feasible, and others.

Our reply/
We very much appreciated these comments. We have already highlighted reviews that were published and mostly addressed about community involvement. This section has been updated for clarity. Thank you

Line #325-330
According to a published review [15], community participation in PHC and water resource governance in South Africa was likewise tokenistic, regarding the Arnstein's ladder of involvement [36]. Since consultations and/or informing were the most typical forms of participation, the Arnstein's ladder of participation [36] was similarly appropriate to the degree of CE in our review of STH.

Line# 334-336
The main mechanisms of CE in this evaluation were small meetings with community leaders, community members, and health personnel, similar to prior reviews that evaluated CE [15,33,35,36].

Reviewer #2:
This study reports important information on CE during STH research that can aid in better planning and research on NTDS in the Asia Pacific.

Major remarks Q/
Authors should refine/revise their search criteria; for example "hook worms" should be there is a clear CE, with head of the villages involved in the study. I would suggest author to re-perform their search. For example, the above study came up with a simple search of hookworm AND Asia AND community.

Our reply/
We very much appreciated your guidance and valuable inputs. We have updated search strategy by adding hookworms and trichuriasis. Following this, we have added two studies on the revised version. Thank you

In the revised version
Line# 132-135 The keywords with appropriate Bolen operators were used: "community engagement" "community participatory" "action research" "participatory research" "participatory action research" "community-based research" "soil transmitted helminths" " hook worms" " ascariasis'' " trichuriasis" Line # 139 S1 be included in the analyses. Some studies in S2 that were deemed as "efficacy" or "cross sectional" are nowhere different from those included in table 1.

Our reply/
In the inclusion criteria, we have described that programme/intervention in the study should involve community/stakeholder involvement or engagement and provide mechanisms and/or 8 processes of community engagement. Moreover, it should be targeted towards health services context. Thank you.
Minor remarks:

Q/
The text needs a thorough revision (e.g., often brackets are opened but not closed).

Our reply/
We have corrected these in the revised version. Thank you

Q/
Line 290: if out of 11, it shouldn't be that %

Our reply/
It is out of ten studies in the revised version. Hence, it becomes 70% (7/10). Thank you

Q/
Line 360: statement not needed

Our reply/
We have removed the statement from the revised version. Thank you

Q/
Line 368: missing a verb Our reply/ 9 We have corrected this sentence. Thank you

Line# 357-358
Findings suggest that various forms of community had engaged in various aspects of the HSR context.