Community mobilization (CM) is a term widely used in public health programs and research studies; however, there is no standard definition and no consensus strategy for its utilization. Although CM shares many characteristics with related concepts such as community development, empowerment, and participation, its emphasis on collective advocacy and organization warrants a unique classification. As an intervention tool in public health, CM seeks to create social change by building awareness and empowering community members to take charge of their own health through engaging in a collective, interactive process [1
]. Although defining the theoretical concept of CM is beyond the scope of this discussion, we seek to illustrate a pragmatic application of community mobilization employed for an HIV prevention intervention in active research settings.
Despite the lack of a consensus definition, CM has been used to foster HIV awareness and prevention in high-income countries for decades [2
]. In low- and middle-income countries, community mobilization has been used to reduce HIV-related stigma [7
], implement a community-based peer education and free condom distribution program [8
], and influence condom use among vulnerable populations [9
Project Accept is the first multi-site community randomized controlled Phase III trial to test the efficacy of a behavioral intervention on reducing HIV incidence. The primary trial hypothesis is that community mobilization, in conjunction with mobile community-based voluntary counseling and testing (VCT) and post-test support services (PTSS), will increase uptake of VCT, stimulate discussions about HIV, reduce stigma, and ultimately decrease HIV incidence [13
]. In low- and middle-income countries, VCT is a moderately effective means of HIV prevention [14
]. With respect to VCT, community mobilization can raise awareness and foster community engagement regarding HIV testing [15
]. Project Accept uses the diffusion of innovations theory as a theoretical basis for community mobilization, which states that four main elements influence the spread of new ideas: innovation, time, communication channels, and a social system [16
]. Community mobilization may influence norms regarding HIV prevention by opening communication channels within the social system and by using innovators (e.g. community mobilizers and opinion leaders) to foster support among social networks, eventually leading to widespread adoption of new behaviors and ideas, including VCT acceptance.
The intervention phase of Project Accept lasted for 3 years and consisted of three components: mobilization, VCT, and post-test support services. Project Accept was implemented in five site locations: Chiang Mai, Thailand; Kisarawe, Tanzania; Mutoko, Zimbabwe; Vulindlela, South Africa; and Soweto, South Africa. The overall project objectives and methods have been previously described elsewhere [13
As support for using environmental and structural-level interventions for HIV prevention grows, investigators have emphasized the need to better understand how such interventions occur and how they are sustained [17
]. However, few studies discuss the complexities of intervention components in detail, and there are few operational examples of intervention strategies such as community mobilization. Furthermore, given that community mobilization is an inherently community-driven process, the role of an external research team in implementing a mobilization intervention remains unclear. This paper seeks to understand how community mobilization was utilized in Project Accept from the research team's perspective, specifically in regards to the formation and adaptation of mobilization strategies.