This research project aims to understand the determinants of public engagement in science success or failure in 5 impoverished urban areas of Johannesburg, South Africa, where a Health, Environment and Development (HEAD) panel study is being conducted by the South African Medical Research Council (SAMRC). All existing and future public engagement activities aim to promote an integrated and evidence-based approach to health, rooted in the specific needs of each community. This project involves conducting an in-depth evaluation of existing engagement activities in the 5 research areas, then developing and evaluating new approaches to engagement around health research.
Existing approaches to community research translation have centred on community-specific presentations to local representatives in each research community and ad hoc 3-way meetings with community representatives, national experts, and government representatives concerning health issues raised by the research. New approaches being rolled out in the duration of the project include: cross-community forums between researchers and community leaders to harness successful experiences in order to engage more effectively in areas where dialogue has so far remained limited; inter-faith representative meetings within research communities to facilitate community mobilisation around health issues; and a mobile photographic exhibition to document public engagement processes and outcomes and facilitate ongoing dialogue.
This ongoing process of internal and external evaluation throughout the duration of the project is designed to strengthen the capacity of South African environmental health researchers to communicate their research findings and implications to a wide range of policy- and planning-related stakeholders. It also aims to provide the wider research community with case studies and best practice recommendations for community engagement with health research. It is hoped that increased collaboration and engagement among research, policy, and community groups, at all stages of the research-policy process, will assist in moving away from a narrow view of stakeholders as "end-users", towards increasingly interactive relationships. With higher levels of community awareness of local public and environmental health concerns, communities will hopefully be in a stronger position to lobby for needed services and facilities.
SAMRC's Environment and Health Research Unit has been partnering with 3 other organisations (the City of Johannesburg, the University of Johannesburg, and the University of the Witwatersrand) to monitor a wide range of social and health-related indicators in: 2 Johannesburg inner city areas, an informal settlement, and 2 low-cost housing developments (one from the apartheid era and another from the democratic era in South Africa). Initiated in 2005, the HEAD study involves the administration of a structured questionnaire to a suitable respondent from the primary household in pre-selected dwellings. It is informed by an environmental approach to health research, which underlines the links between health and its demographic, socio-economic, and lifestyle determinants. Over the past 5 years, the research has highlighted particular health needs in the research communities, such as high rates of diabetes, asthma and suicide, and related environmental, lifestyle, and socio-economic factors. This may include such factors as pest infestations, high levels of smoking, and food insecurity.
The main vehicles for feeding research information back to the 5 communities have been research reports and PowerPoint presentations to elected leaders. Presentations have highlighted associations between social determinants and health, placing each community in the wider context of the study. The responses from communities to these engagement efforts have varied widely. In one community (Riverlea), an early presentation of the study findings prompted the formation of a community development trust, the main objective of which is to respond to further evidence from the HEAD study. In Riverlea, the HEAD study findings have been translated into several projects of local and national significance, including food security initiatives, rodent control programmes, increased availability of targeted services at the local health clinic, and widespread media coverage of hubbly bubbly (hookah pipe) smoking. However, in other HEAD study communities there has, to date, been a relatively apathetic response to the HEAD study.
The following strategies/activities of this project are designed to evaluate these existing engagement activities and introduce and evaluate new approaches to dialogue and research translation initiatives.
- With the goal of developing new methods of engagement suggested by local representatives in each area in ways that equip them to engage with their wider communities on issues raised by the health research, organisers are conducting:
- A local political (inter-councillor) meeting, held on January 25 2012, between 2 of the 5 ward councillors overseeing the communities in which the HEAD study is being conducted. (Organisers say that attendance was poor despite every attempt to accommodate their busy schedules and considerable prior effort in maintaining contact with invitees to facilitate participation in the meeting). The forums aimed to harness successful research translation experiences conducted in some areas in order to guide ward councillors in areas where previous engagement activities have been less successful.
- A mini-conference of faith-based leaders (FBLs) was held on March 13 2012. The purpose of the meeting was to inform FBLs about the HEAD study, some of the key health and social issues emerging from it, and their potential role engaging with communities on issues of concern. According to organisers, the FBLs expressed a high degree of interest in serving as a mechanism of engagement with their congregations and the broader community on health and social concerns. The researchers concluded that this avenue should be further developed in the project as a means of reaching out to a large cross-section of the study communities. There will be a further meeting of FBLs to consolidate their role in community environmental health awareness. Also planned are the preparation, packaging, and distribution of an urban environmental health information pack for FBLs, including fact sheets on: food insecurity and hunger; mental illness and the environment; and keeping children cool in a context of increasing climate variability.
- A mobile photographic exhibition called "Visions and Voices" was launched on launched on August 21 2012 at the University of Johannesburg. A total of 20 volunteers were selected from the 5 study sites for training in basic photography by an international expert in community-based research through photography. These trained volunteers were asked to take photographs of the best and worst environment and health conditions in their neighbourhoods and to write up an accompanying narrative to explain their reasons for selecting and capturing that specific image. At the same time, a professional photographer visited the homes of each of the volunteers to photograph them within or close to their home settings. The resultant photographs were mounted and exhibited at the launch event, where attendees and members of the media had the opportunity to engage with the volunteers and researchers. Subsequently, the exhibition will be used as a visual reference at all community engagement workshops and other events, explaining the process of community engagement. The exhibition will summarise major findings of the HEAD study, community initiatives developed in response to research findings, and national and local media coverage. The exhibition will aim to provide evidence of tangible outcomes and support an environment conducive to stakeholder debate.
- In an effort to evaluate existing and new engagement activities, organisers are using a combination of process and outcome evaluation methods to provide HEAD study researchers and the wider health community in South Africa with tools for positive community engagement around health research. Namely, evaluations of existing HEAD activities will be conducted with participants of community stakeholder engagement workshops and participants of national health issue representative discussions. Evaluations of new engagement activities developed as part of the above-summarised project will be conducted with each of the stakeholder groups (ward councillors, faith representatives, and viewers of the photographic exhibition). Evaluation findings will be disseminated within the broader health community via the SAMRC website and peer-reviewed publications in health-related journals.
- In an effort to evaluate the project in its entirety, across time and research communities, organisers will:
- By area: for each of the 5 communities, conduct evaluations of project events for longitudinal variation (for example, increased levels of attendance at community stakeholder events). New events and initiatives initiated by community stakeholders will be recorded and compared over time.
- By type of relationship: Comparative assessments will evaluate the development of relationships with ward councillors and their impact on health research outcomes, critically reflecting on reasons for different trajectories. Similarly, relationships with religious representatives and issue experts will be analysed for their contribution to the research engagement process.
- By outcome: Retrospective analysis of factors contributing to successful outcomes - for example, an increased level of initiative in convening community stakeholders by a ward councillor - will be analysed in the broad context of the whole project.
- By media coverage: "While this is not a stated aim of the project, we have seen that media coverage of initiatives born out of dialogue between research and community stakeholders has contributed to enthusiasm and momentum facilitating greater ongoing engagement."
In addition, a progress meeting will be used to reflect on lessons learned so far and integrate potential necessary changes to the project implementation. This workshop will be attended by the applicants, researchers, and project team members involved in research translation activities. Internal and external evaluation findings will be presented and summarised and will inform discussion regarding overall reflections relating to the entire project.
Following the completion of the project, organisers will use lessons learned in the course of the project and documented in the final report to develop models of best practice, which organisers will promote throughout the SAMRC (more than 800 staff). Recommendations arising from the project will guide existing relationships with government and community stakeholders and the development of new relationships in the future. Positive experiences will be scaled up in future research translation activities.
SAMRC will disseminate experiences of research translation and dialogue through existing institutional channels, including websites and research briefs. A project summary will be placed on the SAMRC website, in addition to PowerPoint presentations, which may be of use to policymakers and local communities. SAMRC will also disseminate findings through publications focusing on the project experience and presentations at relevant conferences.
Several developments emanating from "Visions and Voices" illustrate the potential of photographic exhibitions as a vehicle for engaging communities in relation to health research. One example is a request received from Dr. Kerrigan McCarthy to discuss urban health research and stage the Visions and Voices exhibition at a church in Linden. This was undertaken on October 20 2012, when Professor Thea de Wet presented the findings of the HEAD study at the St. Thomas Anglican Church Health Day to around 30 parish members, including representatives from Soweto and inner city Johannesburg. The programme included several other presentations on health and marked the start of a week-long display of the Visions and Voices photographs.
Funded by the Wellcome Trust.
"International Engagement Awards: Projects funded in 2011" [PDF], accessed on November 28 2012; and email from Angela Mathee to The Communication Initiative on November 28 2012.