Community-structures that facilitate engagement in health research: Ifakara Health Research Institute-Bagamoyo case study.

Background: Involvement of communities in health research has been at the forefront of ethical conduct of research worldwide. Despite the fact that many scholars have put forward different ways of engaging communities in health research, debates on the forms and goals of engagement, levels of engagement, who should be engaged in the community and how, still persist. At the Ifakara Health Research Institute (IHI) in Bagamoyo, Tanzania, different approaches to engaging with the community in health research have been used over the last decade. Of the approaches that have been used, are the use of community structures including traditional and administrative leaders, which have been periodically engaged, but with little sharing beyond study-level. Therefore, the present research was aimed to describe the nature of community structures that could be engaged in health research at the Ifakara Research Centre, the strength and weakness of working with such community structures, and the impact of the structures on research conducted in the center, including promoting research participation.

Methods: A qualitative study based on social science methodological design and a thematic approach for data analysis was employed. Data collection was undertaken in between February 2019 and December 2019. In this study, a total of 25 interviews with 55 respondents in which 19 were In-Depth Interviews (IDIs), and 6 were Focus Group Discussions (FGDs) were carried out. The In-Depth Interviews (IDIs) involved Village Executive Officers (VEOs), Hamlet Leaders (HLs), Community Health Workers (CHWs), Principal Investigators (PIs), study coordinators (SCs), research project managers (PMs), and field workers (FWs), while 6 Focus Group Discussions (FGDs) involved community respondents who previously participated in IHI research. The FGDs were conducted in 3 villages; two FGDs in each village, one each for men and women. The interviews were audiotaped, transcribed, and analyzed using framework analysis. Comparative thematic analysis was undertaken as more data was added, creating new themes, until there was no new emerging themes, a point of data saturation. The themes were charted across respondent groups to map patterns of the themes across respondents groups.

Results: Data shows different community structures including the village executive officers, community health workers, hamlet leaders, and community advisory board were involved in engagement activities. Approaches used for engagement as per the findings under this study include community-level public meetings, information giving at household level and at the health facilities, the use of outpatient attendance at hospital/dispensary, the use of Health District Coordinators, the use of some members of village leaders/representatives families through their both informed assent and consent as project or research participants, and the use of routine health care campaigns in the community to create awareness of the particular diseases such as Tuberculosis day (TB day), Malaria day and HIV day. The weaknesses that were reported include inconsistence research feedback, insufficient engagement with participants about specific research projects they are recruited into and false promises by researchers to community stakeholders. Community stakeholders suggested additional ways to engage with the community, these include radio, advertisement, posters, brochures and regular meetings.