One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field.

/pdf/implementation-research-in-mental-health-services-an-l0vne0s72v.pdf

Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges

As a key principle of Primary Health Care (PHC) and Health Systems Reform, community participation has a prominent place in the current global dialogue. Participation is not only promoted in the context of provision and utilization of health services. Advocates also highlight participation as a key factor in the wider context of the importance of social determinants of health and health as a human right. However, the evidence that directly links community participation to improved health status is not strong. Its absence continues to be a barrier for governments, funding agencies and health professionals to promote community participation. The purpose of this article is to review research seeking to link community participation with improved health status outcomes programmes. It updates a review undertaken by the author in 2009. The search includes published articles in the English language and examines the evidence of in the context of health care delivery including services and promotion where health professionals have defined the community’s role. The results show that in most studies community participation is defined as the intervention seeking to identify a direct causal link between participation and improved health status modeled on Randomized Control studies (RCT). The majority of studies show it is not possible to examine the link because there is no standard definition of ‘community’ and ‘participation’. Where links are found, they are situation-specific and are unpredictable and not generalizable. In the discussion, an alternative research framework is proposed arguing that community participation is better understood as a process. Once concrete interventions are identified (i.e. improved birth outcomes) then the processes producing improved health status outcomes can be examined. These processes may include and can lead to community uptake, ownership and sustainability for health improvements. However, more research is needed to ensure their validity.

/pdf/examining-the-links-between-community-participation-and-rvv5pdaj0q.pdf

Examining the links between community participation and health outcomes: a review of the literature

Chasing the dragon: Developing indicators for the assessment of community participation in health programmes.

Background
Community participation is increasingly seen as a pre-requisite for successful health service uptake. It is notoriously difficult to assess participation and little has been done to advance tools for the assessment of community participation. In this paper we illustrate an approach that combines a ‘social psychology of participation’ (theory) with ‘spider-grams’ (method) to assess participation and apply it to a Community-based Health Planning and Services (CHPS) programme in rural Ghana.

/pdf/assessing-participation-in-a-community-based-health-planning-41e5jg3gms.pdf

Assessing participation in a community-based health planning and services programme in Ghana

This article examines the tensions and challenges of a graduate student maneuvering the institutional hierarchies in her journey of participatory action research (PAR). By using a first-person action research framework, the researcher moves back and forth exploring the prose of others, and revealing her reflexive self-inquiry of underlying assumptions and beliefs. Iterations of insider-outsider positionality, drawing on and integrating paradigms, reconciling multiple roles and perspectives, exploring the complexity of power relations, and uncovering the promises and perils of PAR, moves the researcher toward a partnership with her community of inquiry. First-person action research unfolds a process of self-transformation.

Lynne Blair

Papers

Evaluating the participatory process in a community-based heart health project.