{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T05:55:36Z","timestamp":1792821336094,"version":"4.5.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rohingya refugees in Bangladesh are vulnerable to infectious diseases such as COVID-19 due to the crowded living conditions with fragile shelters, and limited water, sanitation and hygiene facilities and practices. While risk communication and community engagement (RCCE) is the cornerstone of outbreak control, there is limited evidence available on the effectiveness of the RCCE strategies in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The goal of this study is to evaluate the effectiveness of RCCE strategies and to explore the challenges and community recommendations in relation to COVID-19 preventive measures in the context of Rohingya refugee camps in Bangladesh.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>It was a qualitative study. Methods used were (a) observation of RCCE intervention by 3 clinical supervisors accompanying 25 Community Health Workers (CHWs) and (b) 5 focus group discussions engaging 60 community representatives. Data were analyzed using a thematic analysis approach, separately for observation and focus group discussions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study identified a number of good practices of RCCE, including selecting CHWs from the local community, engaging female CHWs, using local dialect, and collaborating with community\/religious leaders. Certain good practices need scaling up, such as utilization of multiple communication methods and interpersonal communication skills. Some areas need improvement, such as CHWs being overburdened with multiple tasks, less effort to active listening, repeated delivery of same messages, inadequate linkage to culture, context, and resources, and less effort to empower the community. Engaging the community, five critical themes were identified in relation to poor COVID-19 preventive practices: culture, religion, and language; local context and resources; community trust and interaction with aid workers; communication methods; and gender and social inclusion. Religious misinterpretation, cultural barriers, physical barriers, lack of resources, breach of trust between the community and aid workers, inconsistent\/complex messages, lack of gender and social inclusion, and stigmatization are among some key factors. Some key actions were recommended to improve COVID-19 RCCE strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We urge the RCCE partners to make use of the findings and recommendations to develop a robust RCCE strategy relevant to local culture and context, responsive to people\u2019s concerns and needs, and inclusive of gender, age and social vulnerabilities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2023.1169050","type":"journal-article","created":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T13:07:09Z","timestamp":1691154429000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Understanding the challenges and gaps in community engagement interventions for COVID-19 prevention strategies in Rohingya refugees: a qualitative study with frontline workers and community representatives"],"prefix":"10.3389","volume":"11","author":[{"given":"Charls Erik","family":"Halder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Abeed","family":"Hasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yussuf Mohamed","family":"Mohamud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marsela","family":"Nyawara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Charles","family":"Okello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Nahid","family":"Mizan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Abu","family":"Sayum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,3]]},"reference":[{"key":"ref1","volume-title":"Rohingya refugees population by location at camp and union level - Cox's Bazar","year":"2021"},{"key":"ref2","volume-title":"2022 joint response plan: Rohingya humanitarian crisis","year":"2022"},{"key":"ref3","volume-title":"Health Sector contingency plan for monsoon and cyclone","year":"2021"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e1003587","DOI":"10.1371\/journal.pmed.1003587","article-title":"Epidemiological, clinical, and public health response characteristics of a large outbreak of diphtheria among the Rohingya population in Cox's Bazar, Bangladesh, 2017 to 2019: a retrospective study","volume":"18","author":"Polonsky","year":"2021","journal-title":"PLoS Med"},{"key":"ref5","volume-title":"Coronavirus disease (COVID-19)","year":""},{"key":"ref6","volume-title":"WHO coronavirus (COVID-19) dashboard with vaccination data","year":"2022"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"157","DOI":"10.23750\/abm.v91i1.9397","article-title":"WHO declares COVID-19 a pandemic","volume":"91","author":"Cucinotta","year":"2020","journal-title":"Acta Biomed"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1794","DOI":"10.4081\/jphr.2020.1794","article-title":"Tackling the COVID-19 pandemic: the Bangladesh perspective","volume":"9","author":"Islam","year":"2020","journal-title":"J Public Health Res"},{"key":"ref9","volume-title":"First coronavirus case at Rohingya refugee camps in Bangladesh | Bangladesh | the Guardian","year":"2020"},{"key":"ref10","volume-title":"Health Sector Cox\u2019s bazar data and information hub","year":"2022"},{"key":"ref11","volume-title":"COVID-19 strategic preparedness and response plan: reinforcing the collective readiness and response in the WHO eastern Mediterranean region","year":"2021"},{"key":"ref12","volume-title":"Advice for the public on COVID-19 \u2013 World Health Organization","year":"2022"},{"key":"ref13","volume-title":"COVID-19 global risk communication and community engagement strategy, December 2020\u2013May 2021: Interim guidanceWorld Health Organization","year":"2020"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1016\/S0140-6736(19)31395-9","article-title":"Health risks of Rohingya children in Bangladesh: 2 years on","volume":"394","author":"Hossain","year":"2019","journal-title":"Lancet"},{"key":"ref15","article-title":"COVID-19 preventive measures in Rohingya refugee camps: an assessment of community compliance and risk communication and community engagement interventions. Under peer review: PLOS ONE","author":"Halder","year":""},{"key":"ref16","volume-title":"Guidance \u2013 sample size for qualitative research","year":"2017"},{"key":"ref17","volume-title":"Focus group discussion","year":"2016"},{"key":"ref18","first-page":"209","article-title":"Effects of sample size on the representativeness of observational data used in evaluation","volume":"21","author":"Moore","year":"1998","journal-title":"Educ Treat Child"},{"key":"ref19","doi-asserted-by":"crossref","DOI":"10.1088\/1755-1315\/117\/1\/012050","article-title":"Focus group discussion in built environment qualitative research practice","volume-title":"IOP Conference Series: Earth and Environmental Science","author":"Omar","year":"2018"},{"key":"ref20","volume-title":"10 steps to community readiness","year":"2022"},{"key":"ref21","volume-title":"10 steps to community readiness: what countries should do to prepare communities for a COVID-19 vaccine, treatment or new test","year":"2021"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"100227","DOI":"10.1016\/j.puhip.2022.100227","article-title":"COVID-19 knowledge, attitude, and practices among the Rohingya refugees in Cox's Bazar, Bangladesh","volume":"3","author":"Jubayer","year":"2022","journal-title":"Publ Health Pract"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"ckab164","DOI":"10.1093\/eurpub\/ckab164.349","article-title":"The role of community health workers in the COVID-19 response in the Caribbean, an exploratory study","volume":"31","author":"Rise","year":"2021","journal-title":"Eur J Pub Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e0001447","DOI":"10.1371\/journal.pgph.0001447","article-title":"Community health workers and Covid-19: cross-country evidence on their roles, experiences, challenges and adaptive strategies","volume":"3","author":"Salve","year":"2023","journal-title":"PLoS Glob Public Health"},{"key":"ref25","volume-title":"Community based health workers: Action after a disaster - the humanitarian response","year":"2016"},{"key":"ref26","volume-title":"Factors impacting the effectiveness of community health workers behavior change","year":"2015"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12960-021-00701-0","article-title":"Contested notions of challenges affecting community health workers in low-and middle-income countries informed by the silences framework","volume":"20","author":"Musoke","year":"2022","journal-title":"Hum Resour Health"},{"key":"ref28","volume-title":"Applying humanitarian standards to fight COVID-19","year":"2020"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e26474","DOI":"10.2196\/26474","article-title":"Impact of the COVID-19 pandemic on older adults: rapid review","volume":"4","author":"Lebrasseur","year":"2021","journal-title":"JMIR Aging"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"102096","DOI":"10.1016\/j.ijdrr.2021.102096","article-title":"COVID-19 risk perception and coping mechanisms: does gender make a difference?","volume":"55","author":"Rana","year":"2021","journal-title":"Int J Disast Risk Reduct"},{"key":"ref31","volume-title":"Risk communication and community engagement strategy coronavirus disease 2019 (COVID-19)","year":"2020"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"E60","DOI":"10.5888\/pcd17.200245","article-title":"Peer reviewed: culture matters in communicating the global response to COVID-19","volume":"17","author":"Airhihenbuwa","year":"2020","journal-title":"Prev Chronic Dis"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"496","DOI":"10.3325\/cmj.2015.56.496","article-title":"The communication aspects of the Ebola virus disease outbreak in Western Africa\u2013do we need to counter one, two, or many epidemics?","volume":"56","author":"Allgaier","year":"2015","journal-title":"Croat Med J"},{"key":"ref34","first-page":"175","article-title":"Working in the shadows: the role of traditional leaders in the management of Covid-19","volume-title":"The Covid-19 Pandemic in South Africa","author":"Mutereko","year":"2022"},{"key":"ref35","volume-title":"COVID-19 global risk communication and community engagement strategy","year":"2022"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1007\/s10943-021-01463-8","article-title":"Role of religious leaders in COVID-19 prevention: a community-level prevention model in Sri Lanka","volume":"61","author":"Wijesinghe","year":"2022","journal-title":"J Relig Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.puhe.2020.05.006","article-title":"Poverty, inequality and COVID-19: the forgotten vulnerable","volume":"183","author":"Patel","year":"2020","journal-title":"Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1169050\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T13:07:31Z","timestamp":1691154451000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1169050\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,3]]},"references-count":37,"alternative-id":["10.3389\/fpubh.2023.1169050"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1169050","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,3]]},"article-number":"1169050"}}