Community engagement is promoted as one way to involve communities in health research. Some questions asked include what is community?
what is engagement? who is engaged on behalf of whom? why is one engaging the other? whose authority/representation/voice do those engaged bring to the process? Are the ones engaging also being engaged? Engagement is said to be a continuum from simple information giving to deeper levels of partnership e.g. in participatory research, that community sensitization maybe one activity within broader community engagement program. Community members employed by research groups (often called fieldworkers) are said to play a key role in community engagement. But, how do they mediate between researchers (their employers), research participants (their community) and their one interests? What moral and ethical challenges do they face and how are these addressed?. Comments/views are very welcome
Nice reflection. The blog by Dina Bogecho two months ago on community engagement provides an understanding and sets the stage for further reflection and where some of your questions can be answered. However, I will contribute here to say the community health workers face some challenges in dispensing their functions in engaging communities. There are two perspectives. If the community health workers are solely recruited by the project happening in the community, their task may be easier and ethics may sometimes be compromised to suit the person who pays the piper. If the community health workers are part of a "community health committee" that participates in running health facilities within the community, they may not be as compromising in terms of ethical standards. Furthermore, their organisation provides a context for confronting researchers objectively when they have concerns with the conduct of the trial. They can even mare the trial process even if no ethical concern is implicated. On the other hand, they can significantly play an integral part in fostering ethically correct research in the community, especially when they are well informed and trained on the broader development objectives of the study beyond the trial. In this way, the conduct of a trial can become easier and cost effective. My insights come from experience working with communities of diverse ethnicities in regions we are characterising for drug and vaccine trials in Cameroon.