What Makes Community Engagement Effective?: Lessons from the Eliminate Dengue Program in Queensland Australia.

Background: Worldwide, more than 40% of the population is at risk from dengue and recent estimates suggest that up to 390 million dengue infections are acquired every year. The Eliminate Dengue (ED) Program is investigating the use of Wolbachia-infected, transmission-compromised, mosquitoes to reduce dengue transmission. Previous introductions of genetically-modified strategies for dengue vector control have generated controversy internationally by inadequately engaging host communities. Community Engagement (CE) was a key component of the ED Program's initial open release trials in Queensland Australia. Their approach to CE was perceived as effective by the ED team's senior leadership, members of its CE team, and by its funders, but if and why this was the case was unclear. We conducted a qualitative case study of the ED Program's approach to CE to identify and critically examine its components, and to explain whether and how these efforts contributed to the support received by stakeholders. Methodology/Principal Findings: In-depth semi-structured interviews were conducted with 24 participants with a range of experiences and perspectives related to the ED Program's CE activities. Our analytic approach combined techniques of grounded theory and qualitative description. The ED Program's approach to CE reflected four foundational features: 1) enabling conditions; 2) leadership; 3) core commitments and guiding values; and 4) formative social science research. These foundations informed five key operational practices: 1) building the CE team; 2) integrating CE into management practices; 3) discerning the community of stakeholders; 4) establishing and maintaining a presence in the community; and 5) socializing the technology and research strategy. We also demonstrate how these practices contributed to stakeholders' willingness to support the trials. Conclusions/Significance: Our case study has identified, and explained the functional relationships among, the critical features of the ED Program's approach to CE. It has also illuminated how these features were meaningful to stakeholders and contributed to garnering support within the host communities for the open-release trials. Our findings reveal how translating ethical intentions into effective action is more socially complex than is currently reflected in the CE literature. Because our case study delineates the critical features of the ED Program's approach to CE, it can serve as a framework for other programs to follow when designing their own strategies. And because the findings outline a theory of change for CE, it can also serve as a starting point for developing an evaluation framework for CE. Author Summary: Community Engagement (CE) is gaining increasing recognition as an important dimension of biomedical, public health and global health research, including neglected tropical disease research. Yet, there has been little agreement about the specific goals of CE and about the best ways to design, conduct, and evaluate it. CE was an integral component of the ED Program's initial open release trials in Queensland, Australia and our retrospective case study of their approach to CE in that setting helps explain why the ED program was well accepted in the host communities of the initial field trials. Our analysis has generated an empirically grounded framework for CE that explains the linkages between the foundational ethical and practical commitments made by the ED program and its funders and the specific operational practices adopted by the ED program, through which these commitments were realized. Our case study also identified how these practices were meaningful to stakeholders and contributed to their willingness to support the ED program, in general, and the open-release trials in particular. This framework provides research funders, investigators, implementation partners, policy makers, research ethics committees and host communities an example to follow when designing their CE strategies and assessing whether CE is being conducted to high ethical standards. [ABSTRACT FROM AUTHOR]