Division of Health Research, School of Health and Medicine, Lancaster University School of Nursing, UK.
Health Soc Care Community. 2011 May;19(3):250-60. doi: 10.1111/j.1365-2524.2010.00976.x. Epub 2010 Dec 8.
Community engagement is central to strategies to promote health and well-being and reduce health inequalities in many countries, particularly interventions which focus on improving health in disadvantaged populations. Despite the widespread use of community engagement approaches, however, there have been relatively few attempts to review the evidence on the impact that participation has on the lives of individuals involved. Drawing on a wider review of evidence carried out on behalf of the National Institute for Health and Clinical Excellence (NICE), this article reports on a rapid review of evidence of the effectiveness of initiatives which seek to engage communities in action to address the wider social determinants of health, to explore individuals' subjective experiences of engagement. The rapid review process was guided by NICE's public health methods manual, adapted to suit the diversity of the evidence. A total of 22 studies were identified containing empirical data on subjective experiences of community engagement for individuals. The findings of the rapid review suggest that the majority of 'engaged' individuals perceived benefits for their physical and psychological health, self-confidence, self-esteem, sense of personal empowerment and social relationships. Set against these positive outcomes, however, the evidence suggests that there are unintended negative consequences of community engagement for some individuals, which may pose a risk to well-being. These consequences included exhaustion and stress, as involvement drained participants' energy levels as well as time and financial resources. The physical demands of engagement were reported as particularly onerous by individuals with disabilities. Consultation fatigue and disappointment were negative consequences for some participants who had experienced successive waves of engagement initiatives. For some individuals, engagement may involve a process of negotiation between gains and losses. This complexity needs to be more widely recognised among those who seek to engage communities.
社区参与是许多国家促进健康和福祉、减少健康不平等的核心策略，尤其是那些关注改善弱势群体健康的干预措施。然而，尽管广泛使用社区参与方法，但很少有人试图回顾参与对所涉及个人生活的影响的证据。本文借鉴了代表国家卫生与临床优化研究所（NICE）进行的更广泛的证据审查，报告了一项关于旨在使社区参与行动以解决更广泛的健康决定因素的举措的有效性的快速证据审查，以探索个人对参与的主观体验。快速审查过程遵循 NICE 的公共卫生方法手册，根据证据的多样性进行了调整。共有 22 项研究确定了包含个人社区参与主观体验的经验数据。快速审查的结果表明，大多数“参与”的个人认为他们的身心健康、自信、自尊、个人赋权感和社会关系都有好处。然而，与这些积极结果形成对比的是，证据表明，社区参与对一些人存在意想不到的负面影响，这可能对幸福感构成风险。这些后果包括精疲力竭和压力，因为参与消耗了参与者的精力、时间和财力。身体残疾的个人报告说，参与的身体要求特别繁重。对于一些经历了连续波参与倡议的参与者来说，协商疲劳和失望是负面后果。对于一些人来说，参与可能涉及收益和损失之间的协商过程。这种复杂性需要在那些试图吸引社区参与的人中得到更广泛的认识。
