Community engagement and the centrality of ‘working relationships’ in health research

Community engagement (CE) is widely accepted as a critical aspect of health research because of its potential to make research more ethical, relevant and well implemented. Although CE activities linked to international health research involving Low and Middle Income Countries (LMICs; see author note) have proliferated and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood to ‘work’.1 Ultimately, the evidence base for CE remains underdeveloped,2 despite increasing scholarship. We conducted a realist review–a theory-driven approach to evidence synthesis—to better understand the causal dynamics of CE practices associated with health research in LMICs.3 We selected large malaria trials as the entry point for the review because there is a well-established tradition of CE in malaria research, and because this area provides a good representation of current CE practice in international biomedical research involving LMICs. In this commentary, we summarise and discuss the key findings and implications of the review. Our review highlighted that at the core of CE in health research is the establishment of ‘working relationships’ between researchers and other local stakeholders, influenced by the culture of engagement in research institutions, in turn, shaped by the wider health research paradigm context (figure 1, adapted from Vincent et al 3). Figure 1 Core Community engagement dynamic of working relationships and influences of context. The centrality of working relationships underscores the importance of relational dynamics in CE. Working relationships are influenced by differences between and among researchers and other local stakeholders in wealth, power and culture, and depend on four mutually reinforcing relational dynamics: