Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
International Research and Exchanges Board (South & South East Asia Centre), 1275 K Street, NW, Suite 600 Washington, DC 20005, USA.
Health Policy Plan. 2021 Mar 26;36(2):205-217. doi: 10.1093/heapol/czaa140.
Community is deemed a central resource for the improvement of health, across disciplines, contexts and conditions. However, what is meant by this term is rarely critically explored. In Global Mental Health, considerable efforts in recent years have been directed towards scaling up 'community' approaches, with variable success, creating the need to better understand approaches to its use. Our study contributes to this need, through a critical review of studies engaging with the term 'community' in relation to women's mental health services in African settings. Our review explored 30 peer-reviewed articles from the past 15 years, which were systematically evaluated for quality of evidence. Studies were then analysed using a blend of conventional and directed content analysis to unpack perspectives on the term's use in intervention and phenomenological studies. We identified four broad categories of community: (1) place (shared geographical location or institutional affiliation), (2) practice (belongingness to a shared activity or profession), (3) symbols (meanings and experiences associated with shared community life) and (4) identity (diagnostic identity around a mental health condition). Analysis identified community of place as the most common primary focus of interest across the sample, with 80% of papers referencing this dimension. We noted that in studies where communities of practice were the focus, this was in relation to leveraging local knowledge to inform or support service delivery of intervention programmes, often designed by outsiders. Implications for future policy and mental health services research are discussed.
社区被认为是改善健康的核心资源，涵盖了不同学科、背景和条件。然而，这个术语的含义很少被批判性地探讨。在全球心理健康领域，近年来，人们为扩大“社区”方法做出了相当大的努力，取得了不同程度的成功，这就需要更好地理解其使用方法。我们的研究通过对过去 15 年中与非洲环境下妇女心理健康服务相关的使用术语“社区”的研究进行批判性回顾，为满足这一需求做出了贡献。我们的综述探讨了 30 篇经过同行评审的文章，对这些文章的证据质量进行了系统评估。然后，我们使用传统和定向内容分析相结合的方法对这些研究进行了分析，以剖析干预和现象学研究中对该术语使用的观点。我们确定了社区的四个广泛类别：（1）地点（共享地理位置或机构隶属关系），（2）实践（属于共同活动或职业），（3）符号（与共同社区生活相关的意义和经验）和（4）身份（与心理健康状况相关的诊断身份）。分析确定了社区的位置是样本中最常见的主要关注点，80%的论文都提到了这一维度。我们注意到，在关注实践社区的研究中，这是为了利用当地知识来为干预方案的服务提供信息或支持，这些方案通常是由外部人员设计的。讨论了对未来政策和心理健康服务研究的影响。
