Project title

A collaborative research initiative cataloguing key community engagement practices embedded in Implementation Research Public Health Projects Involving Disadvantaged (rural/indigenous) Communities in India.

The project Eco-researchTM (Engagement of Communities in research in Tuberculosis and Mental Health) focuses on improving the engagement of communities in research and in social innovations to enhance healthcare delivery.

Funding

SPECIAL PROGRAMME FOR RESEARCH AND TRAINING IN TROPICAL DISEASES (TDR) co-sponsored by UNICEF, UNDP, the World Bank and WHO and is hosted at WHO (World Health Organization).

Forum for Medical Ethics Society (FMES) secured a grant from the WHO for a research initiative in the domain relating to significance of community engagement in implementation research context.  WHO-TDR initiative, under which this project has been supported, intends to map current community engagement practices to identify good practices, and have a better understanding of the factors and barriers in engaging with communities in implementation research and social innovation in health.

We are one of the ten proposals that were awarded the grant by the WHO-TDR initiative.

Collaborating partners:

For this project, FMES has collaborated with two public health interventions namely, RATIONS (Reducing Activation of Tuberculosis by Improvement of Nutritional Status) and TeaLeaf (Teachers Leading the Frontlines).

RATIONS, which is being implemented in four districts of Jharkhand, is led by Dr Anurag Bhargava, Department of General Medicine and Dr Madhavi Bhargava, Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, in collaboration with colleagues from National Institute for Research in Tuberculosis (NIRT), Chennai and National Institute of Nutrition (NIN), Hyderabad. Both are also associated with the Center for Nutrition Studies, Yenepoya (Deemed to be University) involved in research and advocacy for public health nutrition.

TeaLeaf, which is improving access to children’s mental healthcare by meeting children in schools, is being implemented in rural Darjeeling and being led by a team comprising of Dr Roshan Rai, Dr Christina Cruz, Priscilla Giri, Dr Rinzi Lama, Dr Michael Matergia, Ms Choden Dupka, and Ms Juliana Vanderburgand colleagues at Darjeeling Ladenla Road Prerna (DLR Prerna), Darjeeling, West Bengal.

Themes/ subthemes/tags: Community engagement practices, Qualitative Research method, Public Health, Implementation Science, Ethics of Implementation Research

Duration: July 2021 – May 2022

Why Eco-researchTM Project

This project aims to use qualitative methods to identify, catalog, and evaluate best practices around community engagement in two sites in India: a TB-nutrition cluster randomized trial RATIONS happening in Jharkhand across four rural districts, and a school mental health intervention TeaLeaf in the Darjeeling hills, West Bengal. We will take a participatory and collaborative approach in the conduct of the studies. We will document and disseminate the learning in a proactive manner, including to our research participants.

What is the potential Impact?

RATIONS and TeaLeaf projects are located in two different settings to address two different health concerns and provide us a significant opportunity to catalog community engagement practices in diverse contexts in more than one way with regard to implementation research. These would provide us insights into contextual factors which influence community engagement and thereby uptake of the health interventions. We consider that this research would be first of its kind and will contribute immensely to the community engagement practices in the implementation research.

The results of our study will inform the ongoing public health initiatives towards their further strengthening, will contribute to the understanding of community and stakeholder engagement that served as enablers or otherwise for local buy-in, and will provide insights into the crucial role that community and stakeholder engagement might play in scaling up of these public health interventions. We will generate booklets for sharing the key findings with the local community members and academic outputs. We will use blogs and leverage social media for sharing project findings. We will also organize dissemination meetings in the communities participating in this research. We also aim to publish a few news articles (commentaries; op-eds) highlighting the importance and processes involved in approaching community engagement in implementation science research.

What is the RATIONS initiative?

RATIONS is designed to address the conceptual and programmatic gap in efforts towards eliminating TB. It is being implemented in four districts of the state of Jharkhand, India. Social determinants are involved in the causation of TB and its adverse outcomes. “We suggest that TB elimination will require an optimal mix of enhanced biomedical and social interventions. TB elimination strategy in India needs a pro-poor model of patient – centered care inclusive of nutritional, psycho-social and financial support, universal health coverage, and social protection; and convergence with multi-sectoral efforts to address poverty, undernutrition, unsafe housing, and indoor pollution.?” (Bhargava et al., 2020).

What is the TeaLeaf initiative of DLR Prerna, Darjeeling?

TeaLeaf is set in the rural Darjeeling Himalayas, a region of the Indian State of West Bengal. Within India, the region is geographically and ethnically distinct. The site for this intervention – TeaLeaf – comprises of low-cost community private schools in rural Darjeeling. In Darjeeling’s current system of care, access to mental health services for rural families is essentially non-existent with a single psychiatrist available for only the most severe cases. Thus, in this setting, “usual care” is typically “no care at all”, and care delivered during the research effectively constitutes the entirety of the mental health system accessible to children.