Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care

Community participation in rural primary health care: intervention or approach?

Robyn Preston A , Hilary Waugh A , Sarah Larkins A C and Judy Taylor A B

A School of Medicine and Dentistry, James Cook University, Douglas, Qld 4811, Australia.

B Spencer Gulf Rural Health School, University of South Australia and University of Adelaide, Nicolson Avenue, Whyalla-Norrie, SA 5608, Australia.

C Corresponding author. Email:

Australian Journal of Primary Health 16(1) 4-16
Published: 17 March 2010


Community participation is considered important in primary health care development and there is some evidence to suggest it results in positive health outcomes. Through a process of synthesising existing evidence for the effectiveness of community participation in terms of health outcomes we identified several conceptual areas of confusion. This paper builds on earlier work to disentangle the conceptual gaps in this area, and clarify our common understanding of community participation. We conducted a research synthesis of 689 empirical studies in the literature linking rural community participation and health outcomes. The 37 final papers were grouped and analysed according to: contextual factors; the conceptual approach to community participation (using a modification of an existing typology); community participation process; level of evidence; and outcomes reported. Although there is some evidence of benefit of community participation in terms of health outcomes, we found only a few studies demonstrating higher levels of evidence. However, it is clear that absence of evidence of effect is not necessarily the same as absence of an effect. We focus on areas of debate and lack of clarity in the literature. Improving our understanding of community participation and its role in rural primary health care service design and delivery will increase the likelihood of genuine community–health sector partnerships and more responsive health services for rural communities.


Abelson J Forest PG Eyles J Casebeer A Martin E Mackean G 2007 Examining the role of context in the implementation of a deliberative public participation experiment: Results from a Canadian comparative study. Social Science & Medicine 64 10 2115 2128 doi:10.1016/j.socscimed.2007.01.013

Adatu F Odeke R Mugenyi M Gargioni G McCray E et al 2003 Implementation of the DOTS strategy for tuberculosis control in rural Kiboga District, Uganda, offering patients the option of treatment supervision in the community, 1998–1999. The International Journal of Tuberculosis and Lung Disease 7 9, Suppl. 1 S63 S71 Pubmed Abstract

Andrews JO Felton G Wewers ME Heath J 2004 Use of community health workers in research with ethnic minority women. Journal of Nursing Scholarship 36 4 358 365 doi:10.1111/j.1547-5069.2004.04064.x Pubmed Abstract

Bang AT Bang RA Baitule SB Reddy MH Deshmukh MD 1999 Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 354 9194 1955 1961 doi:10.1016/S0140-6736(99)03046-9 Pubmed Abstract

Baqui AH El-Arifeen S Darmstadt GL Ahmed S Williams EK et al 2008 Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet 371 9628 1936 1944 doi:10.1016/S0140-6736(08)60835-1 Pubmed Abstract

Bedelu M Ford N Hilderbrand K Reuter H 2007 Implementing antiretroviral therapy in rural communities: the lusikisiki model of decentralized HIV/AIDS care. The Journal of Infectious Diseases 196 Suppl. 3 S464 S468 doi:10.1086/521114 Pubmed Abstract

Bhutta ZA Memon ZA Soofi S Salat MS Cousens S Martines J 2008 Implementing community-based perinatal care: results from a pilot study in rural Pakistan. Bulletin of the World Health Organization 86 6 452 459 doi:10.2471/BLT.07.045849 Pubmed Abstract

Bradley M (1997) Building partnerships with the community for health promotion. In ‘Rural and remote health papers 1991–2009’. (National Rural Health Alliance: Canberra) (CD-ROM)

Brady M , Byrne J , Henderson G (2003) ‘Which bloke would stand up for Yalata?’ The struggle of an Aboriginal community to control the availability of alcohol. Australian Aboriginal Studies 2003(Fall), 62.

Braun KL Tsark JU Santos L Aitaoto N Chong C 2006 Building Native Hawaiian capacity in cancer research and programming. A legacy of ‘Imi Hale. Cancer 107 Suppl. 8 2082 2090 doi:10.1002/cncr.22157 Pubmed Abstract

Cheers B , Luloff AE (2001) Rural community development. In ‘Rurality bites, the social and environmental transformation of rural Australia’. (Eds L Bourke, S Lockie) pp. 129–142. (Pluto Press: Sydney)

Collins Y (2001) The more things change, the more they stay the same: health care in regional Victoria. In ‘Rurality bites, the social and environmental transformation of rural Australia’. (Eds L Bourke, S Lockie) pp. 103–117. (Pluto Press: Sydney)

Eyre R Gauld R 2003 Community participation in a rural community health trust: the case of Lawrence, New Zealand. Health Promotion International 18 3 189 197 doi:10.1093/heapro/dag014 Pubmed Abstract

Field P , McLay A , Grundy J (2001) Laramba family wellness model: Integration, sustainability and transferability. In ‘6th National Rural Health Conference, Canberra, ACT, 4–7 March 2001’. (Ed. G Gregory) (National Rural Health Alliance: Canberra)

Fitzpatrick J Ako W 2006 Empowering the intitiation of a prevention strategy to combat malaria in Papua New Guinea. Rural and Remote Health 7 693

Fleming M-L Higgins H Owen N Clavarino A Brown W et al 2007 Community capacity Building for Health Promotion: Lessons from a Regional Australian initiative. Australian Journal of Primary Health 13 3 22 28

Frankish C Kwan B Ratner P Higgins J Larsen C 2002 Challenges of citizen participation in regional health authorities. Social Science & Medicine 54 1471 1480 doi:10.1016/S0277-9536(01)00135-6

George M , Masotti P , MacLeod S , Van Bibber M , Loock C , et al (2007) Bridging the research gap: aboriginal and academic collaboration in FASD prevention. The Healthy Communities, Mothers and Children Project. 13th International Congress on Circumpolar Health, Novosibirsk, Russia, 12–16 June 2006. Alaska Medicine 49(2 Suppl.), 139–141.

Goodrow B Scherzer G Florence J 2004 An application of multidisciplinary education to a campus-community partnership to reduce motor vehicle accidents. Education for Health 17 2 152 162 doi:10.1080/135762804100010001710978 Pubmed Abstract

Government of South Australia (2008) Draft strategy for planning South Australia’s health services. Government of South Australia, Adelaide.

Guterbock TM 1999 Community of interest: Its definition, measurement, and assessment. Sociological Practice Review 1 2 88 104

Hancock L Sanson-Fisher R Perkins J McClintock A Howley P Gibberd R 2001 Effect of a community action program on adult quit smoking rates in rural australian towns: the CART project. Preventive Medicine 32 2 118 127
doi:10.1006/pmed.2000.0798 Pubmed Abstract

Hill K (2007) Royal Flying Doctor Service Field days: supporting access to primary health care for people living in remote north Queensland utilising a capacity building approach. In ‘9th National rural health conference, Albury, NSW, 7–10 March 2007’. (Ed. G Gregory) (National Rural Health Alliance: Canberra) Available at [Verified 25 January 2010]

Hodgson M (2003) Planning with rural communities: to hit and not miss. In ‘7th National Rural Health Conference, Hobart, Tas., 1–4 March 2003’. (Ed. G Gregory) (National Rural Health Alliance: Canberra) Available at [Verified 25 January 2010]

Jacobs B Price N 2006 Improving access for the poorest to public sector health services: insights from Kirivong Operational Health District in Cambodia. Health Policy and Planning 21 1 27 39 doi:10.1093/heapol/czj001 Pubmed Abstract

Kenny P (1999) Aboriginal youth development: a community based program in far west NSW. In ‘5th National Rural Health Conference, Adelaide, SA, 15–17 March’. (Ed. G Gregory) (National Rural Health Alliance: Canberra) Available at [Verified 25 January 2010]

Kidane G Morrow RH 2000 Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial. Lancet 356 9229 550 555 doi:10.1016/S0140-6736(00)02580-0 Pubmed Abstract

Kilpatrick S 2009 Multi-level rural community engagement in health. The Australian Journal of Rural Health 17 39 44 doi:10.1111/j.1440-1584.2008.01035.x Pubmed Abstract

Kilpatrick S Cheers B Gilles M Taylor J 2009 Boundary crossers, communities, and health: Exploring the role of rural health professionals. Health & Place 15 284 290 doi:10.1016/j.healthplace.2008.05.008 Pubmed Abstract

Kironde S Kahirimbanyi M 2002 Community participation in primary health care (PHC) programmes: lessons from tuberculosis treatment delivery in South Africa. African Health Sciences 2 1 16 23 Pubmed Abstract

Lobo R Brown G Edwards J 2007 Developing locally relevant outreach programs for same sex attracted youth in regional areas. Health Promotion Journal of Australia 18 2 109 112 Pubmed Abstract

Loos C , O’Hara L , Dingle M (1997) Issues in local community participation, experiences of the Kolan Injury prevention Program. In ‘Rural and remote health papers 1991–2009’. (National Rural Health Alliance: Canberra) (CD-ROM)

Manandhar DS Osrin D Shrestha BP Mesko N Morrison J et al 2004 Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomised controlled trial. Lancet 364 970 979 doi:10.1016/S0140-6736(04)17021-9 Pubmed Abstract

National Health and Medical Research Council (2000) ‘How to use the evidence: assessment and application of scientific evidence.’ (National Health and Medical Research Council: Canberra)

National Rural Health Alliance (2000) ‘Health Horizons 1999–2003: A framework for improving the health of rural, regional and remote Australians. A joint development of the National Rural Health Policy Forum and the National Rural Health Alliance for the Australian Health Ministers’ Conference.’ (National Rural Health Policy Forum and the National Rural Health Alliance: Canberra)

National Rural Health Alliance (2002) Healthy Horizons, progress against the Healthy Horizons framework for improving the health of rural and remote Australians. Report to the Australian Health Ministers Advisory Council, Canberra.

Ndiaye SM Quick L Sanda O Niandou S 2003 The value of community participation in disease surveillance: a case study from Niger. Health Promotion International 18 2 89 98 doi:10.1093/heapro/18.2.89 Pubmed Abstract

Nikniaz A Alizadeh M 2007 Community participation in environmental health: Eastern Azerbaijan Healthy Villages project. Eastern Mediterranean Health Journal 13 1 186 192 Pubmed Abstract

O’Meara P , Houge T (2003) Saving Helimed: The power of community action in country Victoria. In ‘7th National Rural Health conference, Hobart, Tas., 1–4 March 2003. (Ed. G Gregory) (National Rural health Alliance: Canberra) Available at [Verified 25 January 2010]

Parker E Meiklejohn B Patterson C Edwards K Preece C et al 2006 Our games our health: a cultural asset for promoting health in Indigenous communities. Health Promotion Journal of Australia 17 2 103 108 Pubmed Abstract

Peddle DN , Turray R , AIM Staff, The women and men of Port Loko District and St Joseph Vocational School (2007) Participatory action research evaluation: Amazonian initiative movement improve the lives of women through livelihood options and reduce female genital mutilation in Port Loco District Mid Term Report, American Refugee Committee, Freetown, Sierra Leone. Available at [Verified 25 January 2010]

Rifkin S 1986 Lessons from community participation in health programs. Health Policy and Planning 1 3 240 249 doi:10.1093/heapol/1.3.240

Rifkin S Muller F Bichmann W 1988 Primary health care: on measuring participation. Social Science & Medicine 26 9 931 940 doi:10.1016/0277-9536(88)90413-3

Rifkin S , Lewando-Hundt G , Draper A (2000) ‘Participatory approaches in health promotion and health planning: a literature review.’ (Health Development Agency: London)

Rosato M Laverack G Howard Grabman L Tripathy P Nair N et al 2008 Alma-Ata: Rebirth and Revision 5. Community participation: lessons for maternal, newborn, and child health. Lancet 372 962 971 doi:10.1016/S0140-6736(08)61406-3 Pubmed Abstract

Rowley KG Daniel M Skinner K Skinner M White GA O’Dea K 2000 Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian aboriginal community. Australian and New Zealand Journal of Public Health 24 2 136 144 doi:10.1111/j.1467-842X.2000.tb00133.x Pubmed Abstract

Sare D , Kirby D (1999) Road Trauma Reduction and Injury prevention participation in Rural Communities. In ‘5th National Rural Health Conference, Adelaide, SA, 15–17 March 1999’. (Ed. G Gregory) (National Rural Health Alliance: Canberra) Available at [Verified 25 January 2010]

Sirivong A Silphong B Simphaly N Phayasane T Bonouvong V Schelp FP 2003 Advantages of trained TBA and the perception of females and their experiences with reproductive health in two districts of the Luangprabang Province, Lao PDR. The Southeast Asian Journal of Tropical Medicine and Public Health 34 4 919 928 Pubmed Abstract

Taylor J Wilkinson D Cheers B 2006 Community participation in organising rural general practice: is it sustainable? The Australian Journal of Rural Health 14 144 147 doi:10.1111/j.1440-1584.2006.00790.x Pubmed Abstract

Taylor J , Wilkinson D , Cheers B (2008) ‘Working with communities in health and human services.’ (Oxford University Press: South Melbourne)

Wallerstein N (2006) What is the evidence on effectiveness of empowerment to improve health? Copenhagen, World Health Organization Regional Office for Europe. Health Evidence Network report. Available at [Verified 1 March 2009]

Warchivker I , Hayter A (2001) An evaluation of a nutrition program in a remote community in central Australia. In ‘6th National rural health conference, Canberra, ACT, 4–7 March 2001’. (Ed. G Gregory) (National Rural Health Alliance: Canberra) Available at [Verified 25 January 2010]

Wilson M (2001) Local health planning to meet the needs of communities. In ‘6th National Rural Health Conference, Canberra, ACT, 4–7 March 2001’. (Ed. G Gregory) (National Rural Health Alliance: Canberra) Available at [Verified 25 January 2010]

World Health Organization (1991) Community involvement in health development: challenging health services. Report of a WHO Study Group, WHO, Geneva.

Zakus J Lysack C 1998 Revisiting community participation. Health Policy and Planning 13 1 1 12 doi:10.1093/heapol/13.1.1 Pubmed Abstract

Export Citation