Study search

Relevant studies were searched in the health-related databases including PubMed, Ovid, Google Scholar, Cochrane Collaboration Library, Database of Abstract of Reviews of Effectiveness. 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”. The search was extended to System for Information on Grey Literature including Social Science Research Network and Evidence for Policy Practice Information and Coordinating Centre (EPPI-Centre), Regional Bibliographic databases (e.g. Australian Education Index, AEI https://www.acer.org/my/library/australian-education-index-aei). Search terms for Ovid are available in S1 Table. The search was limited to English language publications between 1995 and June 2022 in LMICs in the WHO-Asia-Pacific region.

Eligible criteria

Individual studies were selected based on the PECOS format.

1. Participants (P): Communities residing in LMICs in WHO defined Western Pacific and Southeast Asia, regardless of age and gender. Communities is as defined in the primary studies.
2. Exposure (E): Program/intervention targeting the health services need within the areas of STH, which involves community/stakeholder involvement or engagement and provide mechanisms and/or processes of community engagement.
3. Context (C): Community- based and/or primary health care settings.
4. Outcome (O): At least one health outcomes (i.e., self-efficacy/self-esteem/ self-regard, behavioral change, beneficial effects), and/or process evaluation (i.e., aiming to understand the functioning of an intervention by examining implementation, mechanisms and contextual factors.
5. Study Design (S): Any study designs that described community-based interventions or study thereof on STH.

Studies were excluded, if they did not include participants from LMIC in the Asia Pacific region. Hence, descriptive studies, knowledge/attitude/practices studies, experimental clinical interventions with clinical outcomes or epidemiological studies that focus on the distribution of diseases were excluded.

Data collection

Two investigators (NHH, CN) independently selected the included studies using pretested data collection sheets.

The two investigators independently collected the following textual data relevant to our review questions and objective:

• study setting, e.g., the geographical setting, the social, and cultural context.
• interventions e.g., type of intervention, how it was delivered, where it was implemented and by whom, funding sources, technical details, and mechanisms targeted by the intervention,
• description of the HSR: e.g., structure, process, outcome assessment
• extent of participants e.g., informed, collaboration, leading, developing the idea, developing methodology, data collection and writing, report writing, dissemination.
• facilitators/barriers encountered.

Any disagreements in these steps were settled by discussion with the third review author (MAW/WST).

Data synthesis

Descriptive statistics were undertaken for the important variables, and reported as frequency (percentage) for categorical data, and mean (standard deviations, SD) for continuous data. We planned to do meta-analysis, if two or more studies provided numerical data of similar outcomes. meta-synthesis. However, a paucity of data in the selected studies precluded to do so.

Community engagement hub

Amongst ten studies included in this review, there were various types of communities involved with variation in the extent of their involvement (Table 1). The participating communities included Aboriginal communities [23, 24], local communities [29] school children and their parents, and sub-groups within these communities such as, school teachers, headmasters of schools, heads of villages [24, 28, 32], local health staff [23, 29] monks [32], voluntary health workers (VHWs) [32], people working in non-health sectors, other government departments such as department of education (DepEd) [25], not for-profit organizations (i.e., Youth Union, Lao Women Union) [32] as well as in the private sector such as animation design experts from animation production companies [23].

CE was heterogeneous across the included studies, and communities’ participations was only in some processes of the research cycles (Fig 3). It was noted that none of the included studies had communities leading/collaborating at ‘developing ideas’ stage. The communities in the studies were involved through being informed the objectives of the study before the commencement of the study. Six studies (60%) had collaboration at ‘developing methodology’ stage [23–26, 30, 31], again mainly through the provisions of an explanation about the objectives of the study or study process. Seven studies (70%) described community participation on STH at ‘data collection’ stage [23, 25–28, 30, 32]. One study (10%) documented that a community leader was involved as a co-author [27], reflecting an involvement in ‘report writing’ and further ‘dissemination’ stage.

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Fig 3. Level and extent of community engagement in various phases of HSR (N = 10 studies).

The role of communities in HSR is ranged from red (lowest level) to green (highest level). Consultation, informed or not involved (Red): score 0; Leading or collaboration (Green): score 1 (adapted from Brunton 2015 [21–22]).

https://doi.org/10.1371/journal.pgph.0001694.g003

In reflecting upon any engagement of communities in the research, some studies described a range of different mechanisms. For instance, the majority (60%) was CE through ‘small community meetings’ [23–25, 29, 30, 32] inclusive of stakeholders such as village heads [24, 25, 29, 30, 32], parents of school children [23], and school teachers [23, 24]. Other mechanisms were: provision of ‘trainings’ to community members [26] including VHWs [26], local government staff [26], community drug distributors [32], and provision of ‘infrastructure and human resources’ (school teachers/headmasters) from DepEd [26, 30]. Overall, the majority of studies (8/10, 80%) were rated as having a moderate level of CE [23, 25–30, 32], and two studies demonstrated at low level of CE [24, 31].

Facilitators and barriers (Table 2)

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Table 2. Barriers and facilitators.

https://doi.org/10.1371/journal.pgph.0001694.t002

Seven studies in this review (7/10, 70%) addressed the ranges of drivers that facilitated CE in HSR targeting STH [23, 25, 27–32]. For instance, communities were motivated to engage through local legislation that could further ensure budgetary support [25], incentives such as awards to communities [31], ‘conditional cash grants’ [30], providing treatment drugs free of charge [32], multisectoral collaboration among stakeholders [23, 26], use of inexpensive local materials [29] and social mobilization [31]. As an example, the requirements of the Pantawid Pamilyang Pilipino program (4 Ps), a government program was that it provided ‘conditional cash grants’ to extremely poor families to ensure that children receive deworming pills twice a year [30]. A study with Orang Asli communities (Aboriginal) in Malaysia stated that “involvement of teachers in such a programme is perceived as being crucial in order to achieve the sustainability and efficiency of the control programme” [23]. However, in the same study it noted that there was concern that involvement of teachers may disturb other forms of school-based activities, and may be an additional burden on the teachers [23].

Studies in the Philippines highlighted that building confidence among school teachers and health workers to implement combined mass drug administration (MDA) facilitated their involvement [25, 26]. These studies also described how multisectoral stakeholder cooperation helped to conserve funds for the initial assessment and management of adverse events (i.e., assurances and rest) by using local health workers provided with sufficient orientation and training rather than using medical doctors [25, 26].

Amongst the barriers stated, common was community members’ doubts about the effectiveness of deworming drugs, and their potential side effects [30], leading to their less involvement. Another barrier to CE was related to the communities’ perceptions of the low quality of the government supplied drugs in the MDA compared to commercially available anthelminthics. For instance, a female participant in mass deworming stated, “I feel like the drug (albendazole) does not automatically kill the worms because some would still come out alive. Unlike with Combantrin (the store-bought drug), worms passed with stool were actually dead” [30]. Communities were finding it difficult to change previous practices of open defecation, according to a study on the use of low-cost sanitary latrines in Indonesia [29].

Summary of evidence

The present review of ten studies from seven LMICs in the Asia Pacific Region revealed minimal/limited CE in the research. We found that the depth of community involvement ranged from the basic (i.e. information being provided to communities) to a collaborative partnership.

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.

CE has been defined as “the process of developing relationships that enable stakeholders to work together to address health related issues and promote wellbeing to achieve positive health impact and outcomes” [33]. In the present review, communities were not limited to being defined as geographically constructed such as in villages, but included social groups united by activities as well.

Comparison with the published reviews

Similar to a published review [34], communities are regulated by power relations such as local governments, which participated in community-based interventions [25, 32]. 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 [35]. Since consultations and/or informing were the most typical forms of participation, the Arnstein’s ladder of participation [35] was similarly appropriate to the degree of CE in our review of STH.

There was also limited description of the community engagement mechanisms utilised in the studies (e.g. for small scale community meetings with health staff, village heads, school headmasters, teachers, parents of school children, NGOs), and creating knowledge gaps in the field, and limiting the expansion of lessons learned in the field. 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, 34–36]. This approach may help build trust between the researchers and the community, and facilitate partnership, as well as provide researchers with local contextual information about the community [8]. However, details about how these “meetings” were organised, managed, and how results from the meetings were incorporated into the research were not discussed in these included studies. It has been hypothesised that increased CE in HSR studies may allow for greater sustainability of the intervention programme e.g., through sharing of resources among health sector and non-health sectors (DepEd in this case), community stakeholders (Aboriginal peoples, NGOs in this case) or promoting collective ownership [37]. In fact, CE in research has gained popularity as an approach for enhancing research, ensuring that community concerns are taken into consideration, and it also inform ethical decision-making when research is undertaken in the context of vulnerability [38].

Study limitations

Due to limited description of the extent of CE, lack of reporting the mechanisms for engagement and sustainability, it was difficult to assess the true extent of CE using the typology developed for this review. The studies included had objectives linked to health outcomes, and ignored non-health outcomes such as social benefits, reduction of inequities (SDG10) and strengthening partnerships (SDG17) [39].