Community mobilisation approaches to preventing adolescent multiple risk behaviour: a realist review

Abstract

Background: Adolescent multiple risk behaviour (MRB) is a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, with systematic reviews reporting mixed evidence of effectiveness. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. There are gaps in the current literature, theory and implementation that would benefit from a realist approach. We use a theory-driven evidence synthesis to assess how and why community mobilisation interventions work/do not work to prevent adolescent MRB and in what contexts.

Methods: This realist review used a six-stage iterative process, guided by the RAMESES framework. We systematically searched PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological Abstracts, from their inception to 2021. Studies were screened for relevance to the programme theory, assessed for rigour and included based on a priori criteria. Two independent reviewers selected, screened and extracted data from included studies. A realist logic of analysis was used to develop context-mechanism-outcome configurations that contributed to our programme theory.

Findings: We reviewed 35 documents describing 22 separate community mobilisation intervention studies. Most studies (n = 17) had a quality assessment score of three or four (out of four). We analysed the studies in relation to three middle range theories. To uphold our theory that these interventions work by creating a social environment where adolescents are less likely to engage in MRB, interventions should: (1) embed a framework of guiding principles throughout the community, (2) establish community readiness with population data and (3) ensure a diverse coalition with the support of intervention champions. Mechanisms such as empowerment through coalition ownership over the delivery of the intervention, cohesion across the community and motivation to work collaboratively to improve adolescent health are triggered to achieve social environment shifts. However, certain contexts (e.g. limited funding) restrict intervention success as these mechanisms are not fired.

Conclusions: For community mobilisation interventions to reduce adolescent MRB, the coalitions within them must seek to alter the social environment in which these behaviours occur. Mechanisms including empowerment, cohesion and motivation lead to this shift, but only under certain contexts.

Systematic review registration: PROSPERO CRD42020205342.

Keywords: Adolescence; Community mobilisation; Complex interventions; Inequalities; Realist review; Risk behaviour.

Fig. 1

Community mobilisation intervention example Legend: A visual representation of the potential stages of implementing and evaluating a community mobilisation intervention. This is an example based on broad commonalities across interventions and is not based on one particular intervention programme

Fig. 2

Stages of realist review Legend: Summary of stages of realist review adapted from Power et al. [ 42 ]. This depicts the steps for developing the initial programme theory, searching for evidence and synthesising the data with the input of key stakeholders (researchers and intervention delivery practitioners within the field of community mobilisation and adolescent health). Retroduction refers to inferences made through interpreting the data about the underlying causal mechanisms

Fig. 3

PRISMA flow diagram of included studies Legend: Flow diagram showing the stages of searching, screening and inclusion that resulted in our final sample to review