Lessons from community engagement to improve COVID-19 diagnosis and treatment in Cochabamba, Bolivia.

BACKGROUND: Community engagement is recognized as a vital component of health-related research and programs, particularly during infectious disease outbreaks and epidemics. Despite the importance of engaging communities in the response to COVID-19, relatively little research has examined how this was (or was not) achieved, and even less in low- and middle-income countries. This article describes the community engagement that accompanied efforts to strengthen COVID-19 diagnosis and treatment as part of the ECO Project in Cochabamba, Bolivia and highlights lessons for future pandemic response. METHODS: Community engagement involved formative assessment, co-creation to develop a health information campaign, ongoing community listening and evaluation. Qualitative data were collected during workshops, project meetings and focus groups. Questionnaire-based surveys were conducted to assess COVID-19-related attitudes, knowledge and practices. RESULTS: The collected data highlighted the value of working closely with well-established community health committees and involving community members with social media skills in the design of COVID-19-related messages to address on- and offline misinformation. Co-creation sessions enabled the adjustment of the information campaign in terms of content and approach based on the needs and preferences of community members and health staff. The continuous listening with community and health personnel facilitated the ongoing adaptation of project activities. CONCLUSION: Through a stepped and multi-pronged approach, incorporating co-creation and community listening, the engagement could respond to emerging local challenges during the pandemic. The project created spaces for dialogue and opportunities for collaboration that strengthened links between the community and the health services.

Main findings Key elements of community engagement to improve COVID-19 diagnosis and treatment in Cochabamba, Bolivia, included working closely with well-established community health committees, involving community members with social media skills in the co-design of COVID-19-related messages, and continuous listening with community and health personnel facilitated the ongoing adaptation of project activities.Added knowledge With little research on community engagement for COVID-19 diagnosis and treatment in Latin America, this study reports the results of mixed methods research on the impact of a comprehensive approach to engagement that highlights lessons for future health emergencies.Global health impact for policy and action Lessons for engagement in health emergencies include the need for a multi-pronged approach, incorporating co-creation and community listening, to respond to emerging local challenges.

Community Engagement and the Effectiveness of Free-Roaming Cat Control Techniques: A Systematic Review.

Although free-roaming and feral cat control techniques are often applied in human communities, community engagement is not always considered. A systematic literature review following an update of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) methodology was conducted to evaluate whether community engagement influences the effectiveness of control techniques, excluding culling, in managing cat populations. The degree of community engagement was estimated based on the number of roles reported during the application of the control technique, which included adoption, trapping, care, and/or education. Education followed by adoption was the determining factor in the decreasing cat populations over time. The limited evaluations of control technique effectiveness, narrow geographical scope, and our simple measure of engagement emphasize the need for more detailed studies. These studies should evaluate the effectiveness of control techniques, while considering community engagement more comprehensively.

Systematic surveillance tools to reduce rodent pests in disadvantaged urban areas can empower communities and improve public health.

Rodents are notorious pests, known for transmitting major public health diseases and causing agricultural and economic losses. The lack of site-specific and national standardised rodent surveillance in several disadvantaged communities has rendered interventions targeted towards rodent control as often ineffective. Here, by using the example from a pilot case-study in the Bahamas, we present a unique experience wherein, through multidisciplinary and community engagement, we simultaneously developed a standardised national surveillance protocol, and performed two parallel but integrated activities: (1) eight days of theoretical and practical training of selected participants; and (2) a three-month post-training pilot rodent surveillance in the urban community of Over-the-Hill, Nassau, The Bahamas. To account for social and environmental conditions influencing rodent proliferation in the Bahamas, we engaged selected influential community members through a semi-structured interview and gathered additional site-specific information using a modified Centers for Diseases Control and Prevention (CDC) exterior and interior rodent evaluation form, along with other validated instruments such as tracking plates and snap trapping, to test and establish a standardised site-specific rodent surveillance protocol tailored for the Bahamas. Our engagement with community members highlighted poor disposal of animal and human food, irregular garbage collection, unapproved refuse storage, lack of accessible dumpsters, poor bulk waste management, ownership problems and structural deficiencies as major factors fuelling rodent proliferation in the study areas. Accordingly, results from our pilot survey using active rodent signs (that is, the presence of rodent runs, burrows, faecal material or gnawed material) as a proxy of rodent infestation in a generalized linear model confirmed that the variables earlier identified during the community engagement program as significantly correlated with rodent activities (and capturing) across the study areas. The successful implementation of the novel site-specific protocol by trained participants, along with the correlation of their findings with those recorded during the community engagement program, underscores its suitability and applicability in disadvantaged urban settings. This experience should serve as a reference for promoting a standardised protocol for monitoring rodent activities in many disadvantaged urban settings of the Global South, while also fostering a holistic understanding of rodent proliferation. Through this pilot case-study, we advocate for the feasibility of developing sustainable rodent control interventions that are acceptable to both local communities and public authorities, particularly through the involvement of a multidisciplinary team of professionals and community members.

Social cartography and satellite-derived building coverage for post-census population estimates in difficult-to-access regions of Colombia.

Effective government services rely on accurate population numbers to allocate resources. In Colombia and globally, census enumeration is challenging in remote regions and where armed conflict is occurring. During census preparations, the Colombian National Administrative Department of Statistics conducted social cartography workshops, where community representatives estimated numbers of dwellings and people throughout their regions. We repurposed this information, combining it with remotely sensed buildings data and other geospatial data. To estimate building counts and population sizes, we developed hierarchical Bayesian models, trained using nearby full-coverage census enumerations and assessed using 10-fold cross-validation. We compared models to assess the relative contributions of community knowledge, remotely sensed buildings, and their combination to model fit. The Community model was unbiased but imprecise; the Satellite model was more precise but biased; and the Combination model was best for overall accuracy. Results reaffirmed the power of remotely sensed buildings data for population estimation and highlighted the value of incorporating local knowledge.

Citizen science expanding knowledge: a new record of the lizard Heterodactylusimbricatus (Squamata, Gymnophthalmidae) in south-eastern Brazil.

Background: Through citizen science projects, like Projeto Bromélias, community members contribute valuable data on species diversity, notably those with low detectability like the Heterodactylusimbricatus lizard. A recent observation in the State of Espírito Santo (south-eastern Brazil), amidst coffee and eucalyptus crops, highlights the utility of widespread technology use in tracking and documenting wildlife. Such initiatives are especially beneficial for mapping the distribution of rare, endemic or endangered reptiles. Therefore, we advocate for more citizen science initiatives near protected areas, involving local communities. New information: We provide a new record for the species Heterodactylusimbricatus, a microteiid lizard of low detectability from the Atlantic Forest of south-eastern Brazil. Heterodactylusimbricatus (Rio de Janeiro Teiid) was recorded near the protected area "Reserva Biológica Augusto Ruschi" by a citizen volunteer who contributes herpetofauna records to the Bromelias Project (https://www.inaturalist.org/projects/projeto-bromelias). Heterodactylusimbricatus is a very poorly-known species in the localities where it occurs, probably due to its fossorial habit, genera's restricted occurrence range, habitat specificity and the absence of proper survey methods fitted to fossorial species, such as the utilisation of pitfall traps. By publishing the records of volunteer citizens, we hope that more people will contribute to increase the knowledge of biodiversity in the mountainous region of Espírito Santo State and expand our collective knowledge.

Lessons for TB from the COVID-19 response: qualitative data from Brazil, India and South Africa.

BACKGROUND: Brazil, India and South Africa are among the top 30 high TB burden countries globally and experienced high rates of SARS-CoV-2 infection and mortality. The COVID-19 response in each country was unprecedented and complex, informed by distinct political, economic, social and health systems contexts. While COVID-19 responses have set back TB control efforts, they also hold lessons to inform future TB programming and services. METHODS: This was a qualitative exploratory study involving interviews with TB stakeholders (n = 76) in Brazil, India and South Africa 2 years into the COVID-19 pandemic. Interview transcripts were analysed using an inductive coding strategy. RESULTS: Political will - whether national or subnational - enabled implementation of widespread prevention measures during the COVID-19 response in each country and stimulated mobile and telehealth service delivery innovations. Participants in all three countries emphasised the importance of mobilising and engaging communities in public health responses and noted limited health education and information as barriers to implementing TB control efforts at the community level. CONCLUSIONS: Building political will and social mobilisation must become more central to TB programming. COVID-19 has shown this is possible. A similar level of investment and collaborative effort, if not greater, as that seen during the COVID-19 pandemic is needed for TB through multi-sectoral partnerships.

CONTEXTE: Le Brésil, l'Inde et l'Afrique du Sud figurent parmi les 30 pays les plus touchés par la TB dans le monde et ont connu des taux élevés d'infection et de mortalité dus au SARS-CoV-2. La réponse au COVID-19 dans chacun de ces pays a été sans précédent et complexe, en raison de contextes politiques, économiques, sociaux et de systèmes de santé distincts. Si les réponses au COVID-19 ont fait reculer les efforts de lutte contre la TB, elles permettent également de tirer des enseignements pour les futurs programmes et services de lutte contre la TB. MÉTHODES: Il s'agit d'une étude exploratoire qualitative comprenant des entretiens avec des acteurs de la lutte contre la TB (n = 76) au Brésil, en Inde et en Afrique du Sud, 2 ans après le début de la pandémie de COVID-19. Les transcriptions des entretiens ont été analysées à l'aide d'une stratégie de codage inductive. RÉSULTATS: La volonté politique ­ qu'elle soit nationale ou infranationale ­ a permis la mise en œuvre de mesures de prévention généralisées au cours de la riposte au COVID-19 dans chaque pays et a stimulé les innovations en matière de prestation de services mobiles et de télésanté. Les participants des trois pays ont souligné l'importance de la mobilisation et de l'engagement des communautés dans les réponses de santé publique et ont noté que l'éducation et l'information sanitaires limitées constituaient des obstacles à la mise en œuvre des efforts de lutte contre la TB au niveau communautaire. CONCLUSIONS: La volonté politique et la mobilisation sociale doivent occuper une place plus centrale dans les programmes de lutte contre la TB. La conférence COVID-19 a montré que c'était possible. Un niveau d'investissement et de collaboration similaire, voire supérieur, à celui observé lors de la pandémie de COVID-19 est nécessaire pour lutter contre la TB par le biais de partenariats multisectoriels.

State of the Art of Participatory and User-led Research in Mental Health in Brazil: A Scoping Review.

Background: Participatory research denotes the engagement and meaningful involvement of the community of interest across multiple stages of investigation, from design to data collection, analysis, and publication. Traditionally, people with first-hand experience of psychiatric diagnoses, services users and those living with a psychosocial disability have been seen objects rather than agents of research and knowledge production. This, despite the ethical and practical benefits of their involvement. The state of the art of knowledge about participatory research in mental health Brazil is poorly understood outside of its local context. The purpose of this article was to conduct a scoping review of participatory and user-led research in mental health in Brazil. Findings: We identified 20 articles that met eligibility criteria. Participation in research was not treated as separate from participation in shaping mental health policy, driving care, or the broader right to fully participate in societal life and enjoy social and civil rights. Studies identified several obstacles to full participation, including the biomedical model, primacy of academic and scientific knowledge, and systemic barriers. Our extraction, charting, and synthesis yielded four themes: power, knowledge, autonomy, and empowerment. Implications of the work: Participation in this context must address the intersecting vulnerabilities experienced by those who are both Brazilian and labeled as having a mental illness. Participatory research and Global South leadership must foreground local epistemologies that can contribute to the global debate about participation and mental health research.

Adoption of community-based strategies for sustainable vector control and prevention.

Community engagement strategies provide tools for sustainable vector-borne disease control. A previous cluster randomized control trial engaged nine intervention communities in seven participatory activities to promote management of the domestic and peri-domestic environment to reduce risk factors for vector-borne Chagas disease. This study aims to assess the adoption of this innovative community-based strategy, which included chickens' management, indoor cleaning practices, and domestic rodent infestation control, using concepts from the Diffusion of Innovations Theory. We used questionnaires and semi-structured interviews to understand perceptions of knowledge gained, intervention adoption level, innovation attributes, and limiting or facilitating factors for adoption. The analysis process focused on five innovation attributes proposed by the Diffusion of Innovations Theory: relative advantage, compatibility, complexity, trialability, and observability. Rodent management was highly adopted by participants, as it had a relative advantage regarding the use of poison and was compatible with local practices. The higher complexity was reduced by offering several types of trapping systems and having practical workshops allowed trialability. Observability was limited because the traps were indoors, but information and traps were shared with neighbors. Chicken management was not as widely adopted due to the higher complexity of the method, and lower compatibility with local practices. Using the concepts proposed by the Diffusion of Innovations Theory helped us to identify the enablers and constraints in the implementation of the Chagas vector control strategy. Based on this experience, community engagement and intersectoral collaboration improve the acceptance and adoption of novel and integrated strategies to improve the prevention and control of neglected diseases.

Epidemiological intelligence community network intervention: a community response for COVID-19 community transmission.

BACKGROUND: Expanding and providing access to early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through testing community-based strategies among socially vulnerable communities (SVC) are critical to reducing health disparities. The Epidemiological Intelligence Community Network (EpI-Net) community-based intervention sought to increase coronavirus 2019 (COVID-19) testing uptake and prevention practices among SVC in Puerto Rico (PR). We evaluated EpI-Net's community leaders' capacity-building component by assessing pre-post COVID-19 public health workshops' tests' score changes and satisfaction among trained community leaders. METHODS: A total of 24 community leaders from SVC in PR have completed four community workshops. Pre- and post-assessments were completed as part of the health promotors training program to evaluate participants' tests score changes and satisfaction outcomes. RESULTS: Preliminary results showed: (1) high intervention retention levels of community leaders (85.7% acceptance rate); (2) change in post-test scores for community engagement strategies (p = 0.012); (3) change in post-test educational scores in COVID-19 prevention practices (p = 0.014); and (4) a change in scores in public health emergency management strategies (p < 0.001). CONCLUSIONS: The overall workshop satisfaction was 99.6%. Community leaders have shown the importance of community capacity building as a key component for intervention feasibility and impact. TRIAL REGISTRATION: Our study was retrospectively registered under the ClinicalTrial.gov ID NCT04910542.

Family listening/circle program: The experience of community action projects to promote family and community wellness in three tribal communities in New Mexico.

Introduction: The Family Listening/Circle Program (FLCP) is a community-based participatory research (CBPR), culture-centered, intergenerational family strengthening program that was co-developed in partnership with the University of New Mexico's Center for Participatory Research (UNM-CPR) and three tribal communities (Pueblo of Jemez, Ramah Navajo, and Mescalero Apache) in New Mexico. The Family Listening/Circle Program brings together fourth and fifth graders, their parents, caregivers, and elders to reduce risky behaviors associated with the initiation of substance use among the youth, and to strengthen family communication and connectedness to culture and language as protective factors. Methods: The tribal research teams (TRTs) from each community worked with UNM-CPR to co-create, pilot, implement, and evaluate the tribally-specific FL/CP curricula centered in their own tribal histories, language, knowledge, visions, and actions for the future. A key component of the FL/CP involved the planning and completion of community action projects (CAPs) by participating families. During the final session of the program, the families present their community action projects on poster boards, with children leading the presentations. The TRTs and UNM team document narratives of what was shared and learned by the families. Results: The CAPs provide an empowerment and community benefit focus based on Paulo Freire's philosophy that people can become agents of change if they identify and work on issues that are important to them. The community action projects are also centered in Indigenous values and practices of reciprocity, responsibility, and being active members of the community. Discussion: The CAPs added unique contributions to the Family Listening/Circle Program as the participants' learnings were strengthened when they had the opportunity to give back to their communities. The CAPs were important to document as they illustrated the potential range of effectiveness with their capacity to empower participants to address challenges within their communities, strengthen cultural norms and values, and improve the wellbeing of community members.

Lessons Learned: Community Engagement in Emergencies in Puerto Rico.

OBJECTIVE: To describe the importance of community engagement from research projects and research centers in times of disasters or emergencies, using the case of Puerto Rico in recent years (2017 - 2022) as an example. METHODS: First, research participants and stakeholders from local community and health organizations were contacted via email and phone calls after each emergency to assess their immediate needs. Second, needs were classified in categories (materials, educational resources, service referrals, and collaborations). Finally, delivery of support was coordinated in a timely manner whether in person or online. RESULTS: Activities were conducted such as handing out materials, providing educational resources, contacting participants, and stakeholders, as well as coordinating collaboration with community and organizations. CONCLUSION: Several lessons were learned from our experiences related to Puerto Rico's recent emergencies as well as some relevant recommendations for future disasters. The efforts presented illustrate the importance of community engagement from academic institutions in disasters. Research centers and research projects, particularly those with community engagement components, should consider providing support in the preparedness phase as well as the recovery phase if necessary. Community engagement in emergencies is crucial to recovery efforts as well as fostering empowerment and making an impact on individual and societal levels.

Listen to the shopkeeper.

His mosquito control project heading for failure, a field entomologist recalls how a chance encounter led to a Eureka moment.

"Community members have more impact on their neighbors than celebrities": leveraging community partnerships to build COVID-19 vaccine confidence.

BACKGROUND: Vaccines are a strong public health tool to protect against severe disease, hospitalization, and death from COVID-19. Still, inequities in COVID-19 vaccination rates and health outcomes continue to exist among Black and Latino populations. Boston Medical Center (BMC) has played a significant role in vaccinating medically underserved populations, and organized a series of community-engaged conversations to better understand community concerns regarding the COVID-19 vaccine. This paper describes the themes which resulted from these community-engaged conversations and proposes next steps for healthcare leaders. METHODS: We accessed nine publicly available recordings of the community-engaged conversations which were held between March 2021 and September 2021 and ranged from 8 to 122 attendees. Six conversations prioritized specific groups: the Haitian-Creole community, the Cape Verdean community, the Latino community, the Black Christian Faith community, guardians who care for children living with disabilities, and individuals affected by systemic lupus erythematosus. Remaining conversations targeted the general public of the Greater Boston Area. We employed a Consolidated Framework for Implementation Research-driven codebook to code our data. Our analysis utilized a modified version of qualitative rapid analysis methods. RESULTS: Five main themes emerged from these community-engaged conversations: (1) Structural factors are important barriers to COVID-19 vaccination; (2) Mistrust exists due to the negative impact of systemic oppression and perceived motivation of the government; (3) There is a desire to learn more about biological and clinical characteristics of the COVID-19 vaccine as well as the practical implications of being vaccinated; (4) Community leaders emphasize community engagement for delivering COVID-19 information and education and; (5) Community leaders believe that the COVID-19 vaccine is a solution to address the pandemic. CONCLUSION: This study illustrates a need for community-engaged COVID-19 vaccine messaging which reflects the nuances of the COVID-19 vaccine and pandemic without oversimplifying information. In highlighting common concerns of the Greater Boston Area which contribute to a lack of confidence in the COVID-19 vaccine, we underscore important considerations for public health and healthcare leadership in the development of initiatives which work to advance health equity.

Evaluating a community engagement model for malaria elimination in Haiti: lessons from the community health council project (2019-2021).

BACKGROUND: Community engagement (CE) plays a critical role in malaria control and elimination. CE approaches vary substantially, with more participatory programmes requiring higher levels of adaptive management. This study evaluates the effectiveness of a volunteer-based CE programme developed in Haiti in 2018. The approach was based on local leaders organizing and implementing monthly anti-malaria activities in their communities, and was implemented as part of Malaria Zero Consortium activities. METHODS: This programme evaluation draws on quantitative and qualitative data collected from 23 Community Health Councils (CHCs) over a two-year period (2019-2021) in Grand'Anse department, a malaria hotspot region in Haiti. RESULTS: Monthly monitoring data showed that 100% of the 23 CHCs remained functional over the two-year period, with an average of 0.90 monthly meetings held with an 85% attendance rate. A high degree of transparency and diversity in membership helped create strong planning and involvement from members. CHCs conducted an average of 1.6 community-based activities per month, directly engaging an average of 123 people per month. High levels of fluctuation in monthly activities were indicative of local ownership and self-organization. This included school and church sensitization, environmental sanitation campaigns, mass education, support for case referrals and community mobilization during mass drug administration (MDA) and indoor residual spraying (IRS) campaigns. Members drew on the tradition of konbit (mutual self-help), local histories of health and development campaigns and a lexicon of "solidarity" in difficult times as they negotiated their agency as community volunteers. Small incentives played both symbolic and supportive roles. Some level of politicization was viewed as inevitable, even beneficial. Rumours about financial and political profiteering of CHC volunteers took time to dispel while the tendency towards vertical planning in malaria control created conditions that excluded CHCs from some activities. This generated resentment from members who felt sidelined by the government malaria programme. CONCLUSION: The CHC model was effective in promoting group solidarity and community-based anti-malaria activities over a two-year period in Haiti. With the end of the Malaria Zero Consortium in early 2021, there is now an opportunity to better integrate this programme into the primary healthcare system, evaluate the impact of the CHCs on malaria epidemiology, and promote the greater integration of CHCs with active surveillance and response activities.

Participação em saúde nas Américas: mapeamento bibliométrico da produção, impacto, visibilidade e colaboração / Participation in health in the Americas: Bibliometric mapping of production, impact, visibility and collaboration / Participación en salud em las Américas: mapeo bibliométrico de producción, impacto, isibilidade y colaboración

Resumo A participação em saúde tem gerado um grande número de publicações em todo o mundo. Para conhecer as especificidades dessa produção nas Américas, foi realizada uma análise bibliométrica de artigos em inglês, espanhol e português. Foram realizadas buscas na BVS, PubMed, SCOPUS, WOS e SciELO, consolidando uma base de dados com 641 referências. Com auxílio do software VOSviewer, analisamos padrões de citação, coautoria e a distribuição cronológica por países e idiomas. Foi possível verificar o crescimento da produção, a relevância quantitativa e o impacto dos diferentes países. A análise indicou que os EUA concentram o maior número de citações, e o Brasil, apesar de ser o primeiro em número de publicações, é o terceiro em número de citações. O mesmo ocorre com os periódicos brasileiros que, com o maior número de artigos, caem no ranking dos mais citados. Nos dez artigos mais citados, descatam-se trabalhos desenvolvidos nos EUA e Canadá. A análise de coautoria indicou que a Universidade de Toronto, a Fiocruz e a Universidade de Harvard são as que mais têm colaborações formais com outras organizações. Concluímos que existem desigualdades de impacto, visibilidade e internacionalização neste campo, indicando obstáculos para o desenvolvimento científico e das políticas de saúde.

Abstract Participation in health has generated a large number of publications around the world. In order to know the specificities of this production in the Americas, a bibliometric analysis of articles in English, Spanish and Portuguese was carried out. Searches were carried out in the VHL, PubMed, SCOPUS, WOS and SciELO, consolidating a database with 641 references. With the help of the VOSviewer software, we analyzed citation patterns, co-authorship and the chronological distribution by countries and languages. It was possible to verify the growth of production, the quantitative relevance and the impact of the different countries. The analysis indicated that the USA concentrates the largest number of citations and Brazil, despite being the first in number of publications, is the third in number of citations. The same occurs with Brazilian journals that, with the largest number of articles, fall in the ranking of the most cited. The co-authorship analysis indicated that the University of Toronto, Fiocruz and Harvard University have the most formal collaborations with other organizations. We conclude that there are inequalities of impact, visibility and internationalization in this field, indicating obstacles to scientific development and health policies.

Resumen La participación en salud ha generado una gran cantidad de publicaciones alrededor del mundo. Para conocer las especificidades de esta producción en las Américas, se realizó un análisis bibliométrico de artículos en inglés, español y portugués. Se realizaron búsquedas en la BVS, Pubmed, SCOPUS, WOS y SciELO, consolidando una base de datos con 641 referencias. Con la ayuda del software VOSviewer, analizamos los patrones de citación, la coautoría y la distribución cronológica por países e idiomas. Se pudo verificar el crecimiento de la producción, la relevancia cuantitativa y el impacto de los diferentes países. El análisis indicó que EE.UU. concentra el mayor número de citas y Brasil, a pesar de ser el primero en número de publicaciones, es el tercero en número de citas. En los diez artículos más citados se descartan trabajos desarrollados en EE.UU. y Canadá. El análisis de coautoría indicó que la Universidad de Toronto, Fiocruz y la Universidad de Harvard tienen las colaboraciones más formales con otras organizaciones. Concluimos que existen desigualdades de impacto, visibilidad e internacionalización en este campo, indicando obstáculos para el desarrollo científico y las políticas de salud.

Reflections on research ethics in a public health emergency: Experiences of Brazilian women affected by Zika.

In Brazil, the epicenter of the Zika crisis, brown, black, and indigenous poor women living in municipalities with scarce resources were disproportionally affected. The gendered consequences of the epidemic exposed how intersectional lenses are central to understand the impact of public health emergencies in the lives of women and girls. The demand for Zika-affected children and women to be research participants is relevant for an ethical analysis of participant protection procedures during a crisis. We investigated how women experienced research participation by analyzing their narratives. Two-year-long longitudinal qualitative study in Brazilian sites located in the epidemic's epicenter was performed using mixed methods: ethnography with women from two distinct states and individual semi-structured interviews with five women in different Zika-affected states, four of which were community leaders. All women in the study were mothers or grandmothers of Zika-affected children. Thematic analysis was used for data evaluation. Women perceived being pressured to participate in research and a lack of benefit sharing. Structural determinants of gender inequality, such as its effect on power distribution, were found to impact research participant protection. Formal procedures for research protocols approvals were insufficient in protecting participants because these instruments were unable to account for structural aspects. Communitarian mobilization, through WhatsApp groups, was found to be an important mechanism to create conditions to challenge oppressive structures. Strengthening public health, effective community-based participation in research planning and implantation of ethical strategies that promotes gender equality can have transformative effect on unequal power structures and promote participant protection.

Implementation of Participatory Research in Vulnerable Context: Methodological Strategies and Challenges / Implementação de Pesquisa Participativa em Contexto de Vulnerabilização: Estratégias e Desafios Metodológicos / Implementación de la Investigación Participativa en un Contexto de Vulnerabilidad: Estrategias y Desafíos Metodológicos

Abstract Participatory methods contribute to scientific rigor by highlighting the contextual needs, especially of underrepresented populations, making them protagonists in the process of social change. This article aims to present the application of a participatory research method, called Community-Based Participatory Research (CBPR), in a context of social vulnerability in southern Brazil. It seeks to discuss the challenges and strengths of the method, which provides ecological validity for the development of public policies appropriate to the context, while empowering the participants. The research has been carried out since 2019 and, among the inherent challenges, has also faced the difficulties posed by the COVID-19 pandemic. Based on the application of this method in Brazil, the importance of involving participants throughout the research process has been identified, so that policies are developed to meet the needs of the community and are sustained by those most interested.

Resumo Métodos participativos contribuem para o rigor científico ao evidenciarem demandas do contexto, especialmente com populações sub-representadas, tornando-as protagonistas do processo de transformação social. Este estudo objetivou apresentar a aplicação de um método participativo de pesquisa, a Community-Based Participatory Research (CBPR), em um contexto de vulnerabilização social no sul do Brasil. Busca-se discutir os desafios e as potencialidades do método, que oferece recursos de validade ecológica para o desenvolvimento de políticas públicas próprias ao contexto, ao mesmo tempo em que empodera seus participantes. A pesquisa vem sendo realizada desde o ano de 2019 e, dentre os desafios inerentes, também enfrentou as dificuldades impostas pela pandemia de Covid-19. A partir da aplicação deste método em contexto brasileiro, identificou-se a relevância de se envolver os participantes ao longo do processo de pesquisa, a fim de que as ações desenvolvidas sejam desenvolvidas em coerência com as demandas trazidas pela comunidade, e mantidas por aqueles que são seus maiores interessados.

Resumen Los métodos participativos contribuyen al rigor científico al destacar las necesidades del contexto, especialmente de las poblaciones subrepresentadas, haciéndolas protagonistas del proceso de cambio social. Este artículo pretende presentar la aplicación de un método de investigación participativa, denominado Investigación Participativa Basada en la Comunidad (IBCB), en un contexto de vulnerabilidad social en el sur de Brasil. Busca discutir los desafíos y fortalezas del método, con validez ecológica para el desarrollo de políticas públicas, al tiempo que empodera a los participantes. La investigación empezó en 2019 y, entre los desafíos, también se ha enfrentado a las dificultades planteadas por la pandemia de Covid-19. A partir de la aplicación de este método en el contexto brasileño, se ha identificado la importancia de involucrar a los participantes en el proceso de investigación, para que se desarrollen políticas que respondan a las necesidades de la comunidad y sean mantenidas por los más interesados.

Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic: a qualitative study.

BACKGROUND: Good governance and regulatory supervision are required to conduct research in an international public health emergency context and to ensure compliance with ethical standards. The "Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic" study is a regional effort in which research ethics stakeholders participated in addressing research ethics governance and preparedness response challenges to the COVID-19 pandemic in Central America and the Dominican Republic. METHODS: A qualitative action research study was conducted following a participatory approach. Research ethics stakeholders in Central America and the Dominican Republic were mapped; a regional webinar and three virtual workshops were conducted discussing research ethics governance, ethics review and collaborative research practice during the pandemic. A roundtable session presented results and obtained feedback on a draft of a policy to strengthen regional research ethics governance. RESULTS: Countries across Central America and the Dominican Republic are at different stages in their development of research ethics systems. Countries with more established systems before COVID-19 were better organized and prepared to respond. This finding argues against improvisation and supports further work on strengthening governance of research ethics systems. Community engagement in research ethics public policy-making is practically absent in the region. Research and research ethics collaboration schemes are lacking amongst the countries; however, there are incipient initiatives in the region, such as the Central America and Caribbean Network of Research Ethics Committees. A policy brief with recommendations on how to advance towards strengthening the governance of research ethics systems was prepared and submitted to the Central American Integration System for analysis and possible approval. CONCLUSION: National research ethics systems in Central America and the Dominican Republic were unprepared to respond to the COVID-19 pandemic with respect to research oversight and effective collaboration. In most cases, national research ethics systems were found to be weak, and regional research collaboration was practically absent. To promote collaboration, a joint strategy needs to be developed with a regional vision towards sharing knowledge and best practices.

Formative Exploration of the Feasibility of Embedding Community Assets Into Primary Health Care: Barbershop and Place of Worship Readiness in Guyana.

INTRODUCTION: Community engagement is key to improving the quality of primary health care (PHC), with asset-based interventions shown to have a positive impact on equity and health outcomes. However, there tends to be a disconnect between community-based interventions and PHC, with a lack of evidence on how to develop sustainable community-primary care partnerships. This paper reports on the formative phases of 2 studies exploring the feasibility of embedding community assets, namely places of worship and barbershops, into the PHC pathway for the prevention and control of NCDs in deprived settings. It describes the participatory approach used to map and gather contextual readiness information, including the enablers and constrainers for collaborative partnerships with PHC. METHODS: Grounded in community-based participatory research, we used elements of ground-truthing and participatory mapping to locate and gather contextual information on places of worship and barbershops in urban and rural communities. Local knowledge, gathered from community dialogs, led to the creation of sampling frames of these community assets. Selected places of worship were administered a 66-item readiness questionnaire, which included domains on governance and financing, congregation profile, and existing health programs and collaborations. Participating barbershops were administered a 40-item readiness questionnaire, which covered barbers' demographic information, previous training in health promotion, and barbers' willingness to deliver health promotion activities. RESULTS: Fourteen barbershops were identified, of which 10 participated in the readiness survey, while 240 places of worship were identified, of which 14 were selected and assessed for readiness. Contextual differences were found within and between these assets regarding governance, accessibility, and reach. Key enablers for both include training in health promotion, an overwhelming enthusiasm for participation and recognition of the potential benefits of a community-primary care partnership. Lack of previous collaborations with the formal health system was common to both. CONCLUSION: The participatory approach extended reach within underserved communities, while the readiness data informed intervention design and identified opportunities for partnership development. Contextual differences between community assets require comprehensive readiness investigations to develop suitably tailored interventions that promote reach, acceptance, and sustainability.

Primate Conservation Efforts and Sustainable Development Goals in Ecuador, Combining Research, Education and Capacity Building.

Ecuadorian primates are a diverse and ecologically important group that is facing severe conservation problems. We present the experiences and lessons learned from two primate conservation projects in eastern and western Ecuador to foster an in-depth reflection of what could be improved to enhance their contribution to the delivery of the Sustainable Development Goals (SDGs). By combining research, education, and capacity building, both projects aim to empower and engage local communities in initiatives to protect primate habitats. These efforts to enhance local environmental sustainability contribute to SDGs 15 (Life on land), 4 (Quality of education), 2 (Zero hunger), 3 (Good health and well-being), 5 (Gender equality), 10 (Reduced inequalities), 12 (Responsible consumption and production), and 13 (Climate actions). One of our findings is that community involvement in conservation activities is not always directly related to an improvement of the conservation status of primate populations. Therefore, continuous monitoring of primate populations and of other relevant indicators is key to assessing the effectiveness of the interventions. We highlight the importance of sharing information between projects with similar scopes and the need to develop local indicators for a more objective assessment of the contribution of small-scale conservation projects to the delivery of the SDGs.