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      Promoting women’s and children’s health through community groups in low-income and middle-income countries: a mixed-methods systematic review of mechanisms, enablers and barriers

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          Abstract

          Introduction

          Community mobilisation through group activities has been used to improve women’s and children’s health in a range of low-income and middle-income contexts, but the mechanisms through which it works deserve greater consideration. We did a mixed-methods systematic review of mechanisms, enablers and barriers to the promotion of women’s and children’s health in community mobilisation interventions.

          Methods

          We searched for theoretical and empirical peer-reviewed articles between January 2000 and November 2018. First, we extracted and collated proposed mechanisms, enablers and barriers into categories. Second, we extracted and synthesised evidence for them using narrative synthesis. We assessed risk of bias with adapted Downs and Black and Critical Appraisal Skills Programme checklists. We assigned confidence grades to each proposed mechanism, enabler and barrier.

          Results

          78 articles met the inclusion criteria, of which 39 described interventions based on a participatory group education model, 19 described community-led structural interventions to promote sexual health in marginalised populations and 20 concerned other types of intervention or multiple interventions at once. We did not have high confidence in any mechanism, enabler or barrier. Two out of 15 proposed mechanisms and 10 out of 12 proposed enablers and barriers reached medium confidence. A few studies provided direct evidence relating proposed mechanisms, enablers or barriers to health behaviours or health outcomes. Only two studies presented mediation or interaction analysis for a proposed mechanism, enabler or barrier.

          Conclusion

          We uncovered multiple proposed mechanisms, enablers and barriers to health promotion through community groups, but much work remains to provide a robust evidence base for proposed mechanisms, enablers and barriers.

          PROSPERO registration number

          CRD42018093695.

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          Most cited references113

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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            The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions

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              Sensitive questions in surveys.

              Psychologists have worried about the distortions introduced into standardized personality measures by social desirability bias. Survey researchers have had similar concerns about the accuracy of survey reports about such topics as illicit drug use, abortion, and sexual behavior. The article reviews the research done by survey methodologists on reporting errors in surveys on sensitive topics, noting parallels and differences from the psychological literature on social desirability. The findings from the survey studies suggest that misreporting about sensitive topics is quite common and that it is largely situational. The extent of misreporting depends on whether the respondent has anything embarrassing to report and on design features of the survey. The survey evidence also indicates that misreporting on sensitive topics is a more or less motivated process in which respondents edit the information they report to avoid embarrassing themselves in the presence of an interviewer or to avoid repercussions from third parties. PsycINFO Database Record (c) 2007 APA, all rights reserved
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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2019
                5 December 2019
                : 4
                : 6
                : e001972
                Affiliations
                [1 ] departmentInstitute for Global Health , University College London , London, UK
                [2 ] departmentFaculty of Life Sciences , University College London , London, UK
                [3 ] Society for Nutrition, Education & Health Action (SNEHA) , Mumbai, Maharashtra, India
                Author notes
                [Correspondence to ] Dr Lu Gram; lu.gram.13@ 123456ucl.ac.uk
                Author information
                http://orcid.org/0000-0002-3905-0465
                Article
                bmjgh-2019-001972
                10.1136/bmjgh-2019-001972
                6936553
                31908874
                abb4e7f4-8dec-4730-b9ee-c4e7c1059be6
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 09 September 2019
                : 23 October 2019
                : 10 November 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 206417/Z/17/Z
                Categories
                Research
                1506
                Custom metadata
                unlocked

                community mobilization,systematic review,mechanism,theory,health promotion

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