School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2021 Dec 2;11(12):e053320. doi: 10.1136/bmjopen-2021-053320.
To understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services.
Realist review.
PubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020.
Criteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible).
Inductive and deductive coding was used to generate context-mechanism-outcome configurations.
73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one's behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation.
The findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.
了解社区参与水和环境卫生干预措施的方式和情况如何影响安全用水和环境卫生的供应、健康状况或行为的改变以及水、环境卫生和个人卫生资源和服务的持久性。
现实主义综述。
使用 PubMed、Web of Science 和 Scopus 数据库，从 2010 年至 2020 年，检索来自低收入和中等收入国家的论文。
制定了纳入论文的标准。根据相关性和严谨性评估每篇论文的贡献（例如，它是否有助于背景、机制或结果，以及用于生成该信息的方法是否可信）。
采用归纳和演绎编码生成背景-机制-结果配置。
纳入了 29 个国家的 73 项研究。我们确定了五个解释供应、变化和持久性结果的机制：（1）问责制（制定政策和程序，要求社区对其行动和干预措施的结果负责）；（2）扩散（随着时间的推移，通过社区成员之间的交流，一个想法或行为由创新者传播）；（3）市场（水环境卫生服务或资源的供求关系）；（4）所有权（对水环境卫生服务或资源的占有感和控制权）；（5）羞耻感（对自己的行为或行动感到厌恶）。确定的背景因素包括社区领导和沟通、技术技能和知识、资源获取和依赖性、委员会活动（如规则和管理计划）、位置以及社区参与程度。
研究结果强调了受 19 个背景因素影响的五个关键机制，这些因素解释了社区水和环境卫生干预措施的结果。决策者、方案实施者和机构在引入社区水和环境卫生干预措施之前，应考虑社区动态、位置、资源、委员会活动和实践以及社区参与的性质。
