Community engagement to support public health: mixed-method evaluation evidence on COVID-19 attitudes and practices...

Community engagement has been recognized as a key tool for supporting national health agendas, and experiences from the COVID-19 pandemic can offer important lessons for tackling future global health challenges such as antimicrobial resistance. This paper provides much-needed evaluation knowledge on relational community engagement initiatives and their impact on COVID-19-related attitudes and practices.

A two-round mixed-method evaluative study to examine outcome indicators related to COVID-19-prevention and health-seeking behavior was implemented from October 2022 to December 2023 among 14 diverse case study communities in four Lao provinces. Data involved 50 semi-structured interviews with villagers, 50 key informant interviews, and two rounds of complete census surveys (3,161 survey observations incl. matched panel data from 618 individuals) to discern outcomes among villagers with different levels of activity participation in a difference-in-difference analysis.

Relative to non-participating villagers, villagers participating in the activities had higher COVID-19 vaccine uptake (+0.13 doses), higher public healthcare utilization for presentations consistent with COVID-19 (e.g. fever and neurological and/or respiratory symptoms; +69.4% points), and less antibiotic use per illness episode (-0.2 antibiotic use episodes). However, the activity raised worries to disclose a COVID-19-positive status and was often interpreted as a health education campaign.

Relational community engagement offers a respectful way of addressing persistent healthcare challenges and supporting vulnerable populations - and thus holds key for ongoing global health priorities such as emerging infectious disease responses and antimicrobial resistance. We recommend that community engagement initiatives become a standard component of national health policy portfolios beyond the scope of COVID-19.