Besigye Innocent, Mash Robert
Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Family Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Glob Health Action. 2025 Dec;18(1):2541979. doi: 10.1080/16549716.2025.2541979. Epub 2025 Aug 7.
Since the declaration of Alma Ata, community participation in health services has been promoted in making services responsive to the needs of the people. This requires effective community engagement approaches. Community dialogues have been used to engage communities in design, implementation and evaluation of health activities and interventions.
This study evaluated the implementation outcomes of a community dialogue intervention that was intended to improve primary care performance in a health sub-district in rural Uganda.
This was a mixed methods study using purposively selected key informants and a data collection form. The key informant interviews were conducted in English using a semi-structured interview guide, audio-taped and transcribed verbatim. Qualitative data was analysed using Atlas ti using a framework approach. Quantitative data was entered into an Excel spreadsheet and analysed into frequencies and percentages.
Overall, 196 community dialogues were conducted by all 16 primary care facilities, and the average attendance was 32 (range 16-46). They were found to be appropriate, acceptable and affordable and, therefore, adopted. They were feasible and implemented with fidelity, encountered minimal contextual barriers and were thought to be sustainable. Thirteen context factors enabled implementation (e.g. prior existence of regular outreach activities at each health facility), while two were barriers (e.g. community members' expectations of incentives). The intervention reached all the health facilities within the health sub-district at no direct incremental cost.
Community dialogues can be implemented through integration at no direct incremental cost and with significant reach to the population served with favourable outcomes.
自《阿拉木图宣言》发布以来，为使卫生服务满足民众需求，一直在推动社区参与卫生服务。这需要有效的社区参与方法。社区对话已被用于让社区参与卫生活动和干预措施的设计、实施及评估。
本研究评估了一项社区对话干预措施的实施效果，该干预旨在改善乌干达农村一个卫生分区的初级保健绩效。
这是一项混合方法研究，采用了有目的选择的关键信息提供者和一份数据收集表。通过使用半结构化访谈指南，用英语对关键信息提供者进行访谈，进行录音并逐字转录。使用Atlas ti软件，采用框架方法对定性数据进行分析。定量数据录入Excel电子表格，并分析为频率和百分比。
总体而言，所有16个初级保健机构共开展了196次社区对话，平均参与人数为32人（范围为16 - 46人）。这些对话被认为是合适、可接受且经济实惠的，因此被采用。它们可行且忠实实施，遇到的背景障碍极少，并且被认为具有可持续性。13个背景因素促进了实施（例如每个卫生机构先前存在定期外展活动），而两个是障碍（例如社区成员对激励措施的期望）。该干预以无直接增量成本的方式覆盖了卫生分区内的所有卫生机构。
社区对话可以通过整合来实施，无需直接增量成本，并且能广泛覆盖所服务的人群，取得良好效果。
