Since 1980, the number of publications of CEPH has been steadily increasing year-on-year, exhibiting the increasing interest of the academic community in this field, as shown in Figure 2. However, there is a significant difference between the two period from 1980 to 2003, and 2004 to 2020. The first period grew smoothly only accounting for 8.96 % of the total publications while the second period accounting for 91.04%. By and large, exponentially growing CEPH has been one of the most influential and dynamic fields of health policy research due to cause celebres in the last two decades.
Figure 3 draws the geographical location of organization that have contributed to CEPH and Table 1 lists numbers of publications and H-index of the most productive 10 countries. The color depth in the figure is proportional to the number of publications, which means the denser the color, the greater the number of articles. It can be seen that the regions with densest red dots are North America and Europe.
Total 117 countries or regions were involved in CEPH, both developed and developing countries participate. The top 10 countries in the number of publications are mainly distributed in the Americas, Europe, Africa and Asia, which means that these countries pay more attention to health issues than other countries. As the country with the highest number of articles published, the United States publishes 51.11% of the world's total publications in CEPH, which has established its leading position in this field. The United States has the highest H index of 46, and far higher than other countries.
As the developing countries in the top 10 countries, South Africa, India, Brazil and China occupy a large number of seats. The reason for this distribution seems obvious: these countries have been plagued by epidemic diseases, and the residents have great health and survival pressure, which forces the countries to look for new ways to improve the current health care pressure.
Table 2 ranks the top ten productive institutions including specific information. Johns Hopkins University is the institution that publishes the most articles, with a total of 70 articles, accounting for 6.35%. Three of the top five institutions belong to the United States. It is worth mentioning that, among the top five institutions, Johns Hopkins University is the agency responsible for the statistics of the new coronary pneumonia in the United States. The fifth-ranked World Health Organization promotes the prevention and treatment of epidemics and endemic diseases and plays a guiding role in improving public health.
Table 3 lists the top ten most productive authors in the CEPH, as well as their H index, total citations, and average citations per item. Among them, England and USA both have three authors, and one from Kenya, China, Australia, Cuba, meaning most productivity authors come from developed countries. The author with the largest total number of articles is South J. from England. A total of 8 articles have been published with an H index of 4 and a total of 65 citations. The highest number of total citations is Cargo M., who comes from Australia, with an average of 130.25 citations per article.
Notably, two authors are found to lead to citation bursts, which shows that these two scholars are field pioneers and play an important role in leading research frontiers and topics.
Global scholars published articles in 483 different international journals. As can be seen from the Table 4, listing the top 10 journals by volume. These journals belong to 103 different categories. Public, Environmental & Occupational Health ranks first in research domain, followed by Environmental Sciences & Ecology, Health Care Sciences & Services, Biomedical Social Sciences, etc. A total of 150 articles were published in the top 10 journals, accounting for 13.61% of the total.
Highly cited publications analysis
Table 5 shows the top 10 highly cited publications. The most cited article is Community-Based Participatory Research Contributions to Intervention Research: The Intersection of Science and Practice to Improve Health Equity, published by Univ New Mexico in the journal American Journal of Public Health in 2010,45 it has been cited 650 times with an average of 65 times a year. In this article, authors identified the obstacles and challenges faced by Community-based participatory research (CBPR) as well as the proposes to improve the imbalance of rights CBPR. Rank second and third papers are from the same journal, Annual Review of Public Health, which has made a great contribution to CEPH. The former solves the problem of minority groups such as African Americans and blacks access to health equity. The latter reviews the public health literature comprehensively, constructs a comprehensive practice framework including developing and maintaining participatory research partnerships, designing and implementing participatory research efforts, and evaluating the intermediate, and long-term outcomes.
Figure 4 lists the 20 publications with the highest “leading trend” in the obtained data. The sudden increase in citations of a publication means that it has received special attention at the very stage, and may make distinguish contributions to the academic field.
Major literature of the top 20 publications focused Community-Based Participatory Research (CBPR). For example, “Using community-based participatory research to address health disparities”,46 “Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity”,45 “Community-based participatory research from the margin to the mainstream are researchers prepared?”,47 and “Community-based research partnerships: Challenges and opportunities” all touched this topic through various perspectives.48 These seminal publications began to increase citations after 2010, which indicates that CBPR has produced a series of innovative thinking and deeply penetrated considerable factors that affect health and disease, such as building partnerships with researchers and local community workers, sharing resources, and exchanging ideas and expertise with each other.
The literature “Chasing the dragon: Developing indicators for the assessment of community participation in health programmes” proposed an assessment framework by capturing multiple ways of community health participation and assesses the role of community participation in improving health.33 The article came in sight in 2012 and shed light on how to evaluate the effectiveness of community participation in improving public health in a comprehensive way.
The literature “Aligning the goals of community-engaged research: Why and how academic health centers can successfully engage with communities to improve health” demonstrated that academic health centers (AHCs) should better interact with community participation research in the future in accordance with the following 5 steps: defining community and identifying partners, learning the etiquette of community-engaged, building a sustainable network of community-engaged researchers, recognizing that community-engaged research will require the development of new methodologies, and improving translation and dissemination plans. Attention to this article began in 2014, suggesting that, from then on, AHCs are beginning to tell in the field of public health.49
The literature “Ebola virus disease in west Africa — The first 9 months of the epidemic and forward projections” retrospected the evolution process of the first 9 months of the Ebola virus epidemic and predicted future development. It highlighted the role of community health participation in epidemic outbreak control in the developing areas.50
The theme of “Applying community engagement to disaster planning: Developing the vision and design for the Los Angeles County Community Disaster Resilience Initiative” and “Getting actionable about community resilience: The Los Angeles County Community Disaster Resilience Project” gave prominence to Community Resilience (CR) which is in accordance with the progress of other disciplines.51,52 Since 2014, a growing number of studies have boosted the discussions and advanced new principles, frameworks, policies, and methods to build community resilience.
Figure 5 shows the strongest intensity of the top 31 keywords in the CEPH and their dynamic evolution from 1991 to 2020. It is obvious that before 2010, the hotspots of CEPH were mainly associated with relatively abstract topics, such as aid, health promotion, association, and empowerment. After 2014, the interests in CEPH shift to more specific subjects, including men, youth, climate change, social determinant, disaster, ebola, and mental health. The narrowing down transition exhibited the consistent changes between burst literature and keywords and formed distinct characteristics of the CEPH development.
Altogether, the analysis of burst keywords and burst literature exhibits the clear evolution progress of CEPH. First, the feature of overall research changes from macro framework design to the medium-micro content investigation. In the early stage, CEPH studies mainly focused on exploring the ultimate purpose, deducing or conceiving the feasible path, and designing the theoretical framework. In the wake of CEPH advancements, scholars have turned their attention to deeper understanding and more specific contents, such as focusing on individual healthcare, targeted chronic diseases, and infection prevention and control (2014-2020).
Second, the evolution of CEPH research reflects vivid age-related features. For example, the outbreak of “Ebola” or “SARS” instantly fueled the academic debate and attracted audiences around the globe, so does the “COVID-19”. To meet these challenges, an international organization, Citizen Science Global Partnership, was founded to explore how citizens can help monitor progress towards the UN’s sustainable development and health equity goals. Then, citizen science in CEPH has begun to take shape and has been increasingly emphasized. Inevitably, “emergency events” with the imprint of the times marked the evolution of CEPH research in recent years.
Keyword co-occurrence and co-citation clustering
The keyword co-occurrence and co-citation clustering maps (Fig. 6 and 7) were created to identify the core themes and the structure of related to the research about CEPH. According to the visual and statistical analysis, the clustering pattern emerged as the following four dimensions: orientation, object, operation, and outcome (See Fig. 8).
The “orientation” dimension delineates the particular interests, activities, or aims of the research about CEPH towards its practical significance or theoretical development. The current literature in this cluster mainly focused on topics related to personal survival, health equity, and ethics. The goal of public health is“the health for all”which consists of 3P - short for prevention of diseases, prolong life, and promotion health.53 The underlying thinking of this ultimate aim reflect serious humanistic solicitude that fairness and morality are just as important to human beings as the individual survival. Communities, in which people live or work closely together and share the same risks,28,33 have emerged as typically embodied organizations to meet the development of public health.13,25,26 Efforts coordinated by communities could facilitate infectious disease control,54 personal hygiene education,55 medical service delivery,56 and environmental improvements,57 and ensure every community member’s basic health resources and equity.45,58 Engaging communities also involves spontaneous and autonomous activities complementary to institutional void or resource constraint, especially in developing countries. Nationwide community mobilization demonstrates deep commitments to collective action and enforce the aggressive disease containment which helps China get a jump on the COVID-19 pandemic.59 Thus, community engagement towards personal survival, health equity, and ethics clearly annotate the spirit of public health.
The “object” dimension refers to a target or a particular group that community engagement is directed at within the context of public health. The major research in this cluster concentrated efforts on child, disadvantaged population, and Africa. To realize the pursuit of public health, the most fundamental and challenging problem is the vulnerable groups and regions. Children, woman, and disadvantaged people (e.g., people with low socioeconomic or be socially excluded) are the typical populations who need extraordinary concerns.13,27 Community engagement, relying on innovative health-care delivery embedded in the community, could timely respond to objective and expressed health demands and overall development by reducing alienation from society for the vulnerable members.60 In Africa, the continent suffering from serious health issues, strengthening weak ties to community groups and institutions does facilitate obtaining information and resources and linking to opportunities. This significantly improves the underlying determinants of health, such as the environment, agriculture, education, and livelihoods, and then leads to better morbidity, mortality, and health inequalities.27 Since the planet is all interconnected in terms of health and well-being, there is an urgent call for providing convenient health and other essential services, and protecting the most vulnerable among us based on community engagement, not only for children and women, but also for ethnic minority, indigenous, immigrant communities, and displaced people.
The “operation” dimension involves the actions or methods that affect the public health improvement through engaging communities. The relevant issues in this cluster included the keywords: qualitative, risk assessment, vaccine, sanitation, general practitioner, prevention science research, extending collaboration, collaboration practice, community research fellows training, and new deal. These keywords specify the main measures or methods of CEPH. That is, engaging communities currently emphasizes cooperation, focuses on prevention, and employs qualitative research methods. General practitioners are still the core suppliers of health service. Sanitation and vaccine are regarded as two cardinal strategies to offer basic living services for people and prevent the spread of the epidemic.61 While collaboration is increasingly highlighted in recent years, substantial disruptions in operations have also been reported from the field. The traditional interventions confined to health facilities only offered faint glimmers without implementation within communities. Big challenges exists to build ability to accurately grasp the complex place-and-time-specific contexts inter-coupling with contemporary public health emergence.62 How community engagement could be designed properly and implemented through effective ways is the guarantee to lead public health on track to reach the goal.
The “outcome” dimension reflects the results or effects of community engagement on public health. Significant studies were crowned with achievements in chronic disease, behavioral health problem, prevalence, Malaria, and Ebola. This dimension is the tangible performance evaluation of CEPH due to specific issues. Involving infectious, chronic and mental disease, public health has a broadening scope related to everyone. Engaging community for public health can be considered to be both conceptually distinct but also practically purposeful in its effects. It could not only fight against epidemics in a collaborative manner, but also alleviate psychological disorder (e.g. depression, PTSD) and build interpersonal trust. For chronic diseases, communities might be the gatekeeper, which is responsible for outpatient follow-up and medication guidance for their ill members, and actively conduct interventions to reduce the rate of injury, disability, and mortality of chronic diseases, then improve health status and quality of life.15 Since results-based evaluation is an incentive assessment of a planned, ongoing, or completed intervention, the focuses of final outcome stemmed from CEPH would ensure its relevance, efficiency, effectiveness, impact, and sustainability. Despite of great progresses, large gaps still exist in the current practice. The lack of systemic design leads to a fragmented situation that various departments independently operate in their own ways. This discordance often brings about duplication of efforts, an exercise in futility, and even a backfire. Inverse care law furtherly distorts the allocation of resources and services resulting in the acute shortage of coverage in the regions that urgently need healthcare on the ground.11,63 Formal and informal institutions are not unanimous proponents of the recognition that there is no public health without community supporting.24,64 Community engagement mechanism is not mature enough when citizens’ rights of participation and supervision are not guaranteed.65
To show the longitudinal patterns related to the 4O dimensions, a quantitative visualization based on the annual number of publication belonged to each dimension is given in Fig.9. The results are familiar with the findings of burst analysis. In the first half of the time, the distribution of 4O is uniform. As people began to focus on to the level of healthcare, scholars are encouraged to pay more attention to new techniques, methods or applications responding to the emerging public health problems. Object and outcome dimensions are evenly consistent. On the contrary, the orientation dimension has the least amount of published articles due to its abstract characteristics. The advancements in orientation would have a bearing on foundations of CEPH.