Fostering community engagement, participation and empowerment for mental health of adults living in rural communities: a systematic review

Introduction: Poor mental health is an under-recognised burden in rural locations. This is evident with suicide rates 40% higher in rural communities compared to urban; despite a similar prevalence of mental disorders. The level of readiness and engagement of rural communities to adapt or even acknowledge poor mental health can impact effective interventions. For interventions to be culturally appropriate, community engagement should include individuals, their support networks and relevant stakeholders. Community participation guides people living in rural communities to be aware and take responsibility of community mental health. Community engagement and participation fosters empowerment. This review examines how community engagement, participation and empowerment were used in the development and implementation of interventions aimed at improving mental health of adults residing in rural communities.
Methods: Databases CINAHL, EmCare, Google Scholar, Medline, PyschoInfo, PubMed and Scopus were systematically searched from database inception to July 2021. Eligible studies included adults living in a rural cohort, where community engagement was used to develop and implement a mental health intervention.
Results: From 1,841 records identified, six met the inclusion criteria. Methods were both qualitative and quantitative, including participatory based research, exploratory descriptive research, community-built approach, community-based initiative, and participatory appraisal. Studies were located in rural communities of United States of America (USA), United Kingdom (UK) and Guatemala. Sample sizes ranged from six to 449 participants. Participants were recruited via prior relationships, project steering committee, local research assistants and local health professionals. All six studies underwent various strategies of community engagement and participation. Only two articles progressed to community empowerment where locals influenced one another independently. The underlying purpose of each study was to improve community mental health. The duration of the interventions ranged from five months to three years. Articles in the early stages of community engagement discovered there was a need to address community mental health. Studies where interventions were implemented resulted in improved community mental health.  
Conclusion: This systematic review found similarities in community engagement when developing and implementing interventions for community mental health. Community engagement should involve adults residing in rural communities when developing interventions; if possible, both with a diverse gender representation and a background in health. Community participation can include upskilling adults living in rural communities and providing appropriate training materials to do so. Community empowerment was achieved when the initial contact with rural communities was through local authorities and there was support from community management. Future use of the strategies of engagement, participation and empowerment could determine if they can be replicated across rural communities for mental health.