This study showed that during pandemics, epidemic management when combined with community participation can be very effective in crisis situations where there is no vaccine or specific treatment for the infected. This project was carried out in a neighborhood-oriented manner with the participation of popular volunteer groups in Iran. In contrast to the huge budgets that were spent on treatment in hospitals and medical centers, the very little direct budget was allocated by the government, and most of the budget was made through voluntary public support. Community engagement refers to the involvement and participation of individuals, groups, and structures within a parameter of a social boundary or catchment area of a community for decision-making, planning, design, governance, and delivery of services. Barker et al indicated that Community engagement refers to the involvement and participation of individuals, groups, and structures within a parameter of a social boundary or catchment area of a community for decision-making, planning, design, governance, and delivery of services. Their findings provided empirical evidence that community participation aims to improve the resilience of the health system to respond to crises (7). It is mainly emphasized that community engagement is seen as critical in many health initiatives, such as for communicable diseases in low and idle-income countries (8). Community engagement and participation have played a critical role in successful disease control and elimination campaigns in many countries. The role of community engagement in disasters has been addressed in different situations and settings (9–12)
March 21 is the first day of the New Year in the Iranian calendar. Usually, 1 to 2 weeks before the New Year, people prepare for the New Year, and weeks 12 to 14 of the beginning of the intervention can be considered the right time to measure outcomes, including death (with 57 cases). In the week before the New Year, unfortunately, the government canceled restrictions on intercity travel during the New Year holidays, which usually start from the first day of Nowruz (New day). The cancellation of travel restrictions naturally increased exposure and the beginning of the fourth peak of the Covid-19 epidemic in Iran.
The role of social participation has been shown in other studies. Gilmore et al (13) in a rapid evidence synthesis concluded that COVID-19's global presence and social transmission pathways require social and community responses. This may be particularly important to reach marginalized populations and to support equity-informed responses. Aligning previous community engagement experience with current COVID-19 community-based strategy recommendations highlights how communities can play important and active roles in prevention and control. Countries worldwide are encouraged to assess existing community engagement structures and use community engagement approaches to support contextually specific, acceptable, and appropriate COVID-19 prevention and control measures.
Many factors influence the effectiveness of community participation in disasters. Factors influencing the effectiveness of community engagement interventions included the extent of population coverage, shared leadership, and community control over outcomes (8).
This is the first ever study conducted through a comprehensive community-based interventional trial to reduce the number of deaths and hospitalizations in Iran. Another positive point of this project was mobilizing people to donate faithfully to needy people and families and to strengthen the sense of social responsibility. People contributed significantly by donating about 450,000 dry food packages, 1.4 million sanitary packages, and one million dollars in addition to voluntary executive assistance during the 4-month implementation of the project. Despite the economic sanctions against the country, these aids played an important role in reducing the burden caused by the epidemic in the more deprived people. Unfortunately, this project did not continue strongly after the government change in Iran. However, nowadays following the pressure and insist of the National Headquarters for Coronavirus Control it is planned to restart the project.
In this study, using statistical models, we tried to control the confounding factors in determining the effectiveness of the desired interventions, however, the before and after experimental studies had their own limitations, and due to ethical considerations, it was not possible to have an independent control group.
The acceptable effectiveness of this project showed that in critical situations such as acute, emerging, threatening and progressive pandemics and other biological threats, the maximum voluntary participation of people can be used, especially in countries with economic and national income restrictions. Moonen et al (14) in Toronto, Canada in a volunteer program involving telephone calls between medical students and older adults showed that after the communication outreach program, medical students' perceptions were positively influenced by older adults and they were more likely to pursue a career concentrated on older adults. The qualitative analysis revealed older adults valued the program. Timing and consistency of calls were factors identified by this group as having practical importance.
Maybe for some experts and specialists in the field of health, social participation has a negative effect on the quality of services, and special attention should be paid to handing over health services to untrained volunteers. The type of services assigned is dependent on the skills of the volunteers, and if necessary, accompanying them with a trained person should be considered. In this project, a wide range of volunteers, including regular workers and specialist doctors, participated in the support, monitoring, and care areas according to their skills. Marston and colleagues argued that mechanisms to ensure citizen participation are essential for high-quality, inclusive disaster response and preparedness, and these can be called upon again in future emergencies. Past experiences to engage communities in disaster management should be our guide. For the next phases of this type of participation, the governments should immediately set up and fund specific community engagement taskforces to ensure that community voice is incorporated into the pandemic response. Engagement with such groups is needed to include their voices in local, regional, or national responses to the pandemic.
Previous studies (14–16) indicated that increasing and improving the process of social participation in disasters requires modifying social interactions and relationships, redesigning the structure and functioning of the associated organizations, improving social and psychological behaviors, as well as providing the contexts. Mao et al (17) identified important factors for fostering community engagement and COVID-19 volunteering as well as gaps in the current literature. According to the results of these studies, promoting useful social participation indicators in natural crises is not possible solely through the formulation of administrative guidelines and non-psychological mechanisms without considering sociological considerations. They believe the reason for the discrepancy between the results may be attributed to the profound social and religious differences in some studied communities.
The support of the intermediate managers of the health sector and the allocation of sufficient funds, as well as the detailed planning along with the strengthening of inter-sectoral cooperation and appreciation of the volunteer forces, are effective factors in increasing the effectiveness of these interventions. The health of the volunteer forces and their families is especially important for those who are in direct contact with infected people, and they should receive adequate training, be continuously empowered, and be provided with the necessary personal protective equipment. In order to continue social participation in crises, it is necessary to plan proper organization and by appreciating their efforts and the important role they play in helping to control crises, we expect their continued cooperation. It is important to believe in the authorities for the important role of social participation in biological threats and to consider this role in policies and plans to deal with them. This study also conclude that Future research should be directed towards deepening knowledge on sustaining community engagement, collaboration and community participation over time, during and beyond this pandemic.