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community involvement has been acknowledged to play a significant role in malaria elimination efforts ( 1 , 2 ) .
many studies confirmed that successful implementation of malaria elimination activities relies on community contribution and supports ( 3 , 4 ) . in recognition of the important role communities
have played in elimination of disease , studies highlighted that the nature of this participation can vary depending on location and setting , resource availability , social and cultural context , political environment and economic conditions ( 3 , 5 ) .
hence , implementing these interventions face challenges due to lack of consensus on what comprises  community and  participation ( 6 ) .
it has been suggested that community beneficially perceive may be considerably enhanced the participation of population ( 7 )
. moreover , level of participation may be influenced by community priorities and acceptability of interventions ( 8) . the need to understand better behavioral , socio - cultural issues and other factors that influence community participation increased ( 9 ) . at present ,
iran is also in the elimination stage of malaria program and due to scale- up of malaria control has already made substantial progress towards elimination of malaria ( 1113 ) .
however , there is little scientific evidence on how to achieve community participation to eliminate malaria .
this study was undertaken to identify key elements for obtaining community interest and motivate them to support malaria elimination .
this study was performed in a multiethnic urban area of bandar abbas city , located on the southern coast of iran the mixed - methods of sequential explanatory involving survey and ethnographic research were used . in review phase ,
our inclusion criteria were studies written in english , published from january 2000 onwards , and related to community participation in malaria elimination interventions .
stratified sampling was conducted to obtain nearly equal proportions of participants from native people , iranian migrant and foreign immigrant groups .
the questionnaire data were analyzed by using the statistical package for social science ( spss 19.0 ) .
we employed an ethnographic research design in qualitative phase involving : participant observation ( po ) , key informant interviews ( kiis ) , and focus group discussions ( fgds ) .
overall , the interviews audio - recorded , lasted on average 60 minutes and was transcribed in full .
ethical approval was granted by the province and district administrative authorities , and by the tehran university of medical sciences . upon informing the study participants on the goal of the study ,
this study was performed in a multiethnic urban area of bandar abbas city , located on the southern coast of iran
the mixed - methods of sequential explanatory involving survey and ethnographic research were used . in review phase ,
our inclusion criteria were studies written in english , published from january 2000 onwards , and related to community participation in malaria elimination interventions .
stratified sampling was conducted to obtain nearly equal proportions of participants from native people , iranian migrant and foreign immigrant groups .
the questionnaire data were analyzed by using the statistical package for social science ( spss 19.0 ) .
we employed an ethnographic research design in qualitative phase involving : participant observation ( po ) , key informant interviews ( kiis ) , and focus group discussions ( fgds ) .
overall , the interviews audio - recorded , lasted on average 60 minutes and was transcribed in full .
stratified sampling was conducted to obtain nearly equal proportions of participants from native people , iranian migrant and foreign immigrant groups .
the questionnaire data were analyzed by using the statistical package for social science ( spss 19.0 ) .
we employed an ethnographic research design in qualitative phase involving : participant observation ( po ) , key informant interviews ( kiis ) , and focus group discussions ( fgds ) .
overall , the interviews audio - recorded , lasted on average 60 minutes and was transcribed in full .
ethical approval was granted by the province and district administrative authorities , and by the tehran university of medical sciences . upon informing the study participants on the goal of the study ,
during review phase , 42 articles met all our inclusion criteria . consequently quality assessment was completed by a high level of agreement ( kappa = 0.9 ) between reviewers .
the evidence highlights that community participation generally has been known to be significant in improving public health and applied in many interventions , there was argument over its actual meaning ( 2931 ) .
research suggested that participatory activity helped community to take control of their own health ( 32 , 33 ) .
finally , our review revealed three main community based malaria elimination activities categories included : stimulating active residency for malaria prevention , improved quality of services and collaborative support .
we also found that a major challenge for countries in elimination phase is prevention and management of imported malaria infections ( 34 , 35 ) . in quantitative phase
461 questionnaires were completed , from native residents ( n=205 ) , iranian migrants ( n=166 ) and foreign immigrants ( n=90 ) .
main occupations of male respondents were fishing and worker while most frequently reported occupation of female was housewife .
regarding to responses to cause of malaria , high differences was observed in reply to source of malaria between groups ( table 1 ) .
respondents knowledge and attitudes to contribute malaria elimination ( predisposing factors ) level of attitude toward community participation in malaria elimination among three groups was moderate to low .
positive responses to enabling factors enclosed three component accesses to educational facilities , health services and social support are demonstrated in table 2 .
respondents access to educational facilities , services and social support ( enabling factors ) table 3 presents reinforcing factors in form of social supporter , social trust , and social norms .
overall , native group reported all social supporters have a positive influence on them , while other groups were not concerned about social supporters . regarding to  influential persons  , total respondents reported both health workers and community health workers could persuaded more for healthy behavior .
respondents view on social supporter , trust , and supportive norms ( reinforcing factors ) note : chw ( community health worker ) in qualitative phase results of observation part , shows that native residents had more informal interactions than other residents did .
communication patterns and decision - making patterns were shown that in some residents , family members communicate freely about their thoughts , but their elders or parents were the final decision makers .
qualitative results were organized in three general thematic areas : perceptions on involvement in malaria elimination , potential barriers to participate in elimination malaria , and focus areas for the training community members .
less than half of the participants reported they were familiar with the malaria elimination activities . some of them , however , felt that involving community health workers were highly effective but they need more appropriate training to do their role .
overall , majority of participants were concern about imported cases from neighboring countries , but they were unaware of their contribution for preventing it .
most of participants were unaware of the benefit of their participation in malaria elimination efforts .
participants cited potential barriers include lack of staff at health facilities , location of health facility , and inadequate malaria education , particularly on malaria transmission .
the focus areas for the training have been identified as : information about importance of malaria elimination and community engagement , their role and responsibility , and communication skills .
it was suggested that for involvement community members in activities towards improving their health , regular community meetings could be a way to increase their capacity for engagement in actions .
less than half of the participants reported they were familiar with the malaria elimination activities .
some of them , however , felt that involving community health workers were highly effective but they need more appropriate training to do their role .
overall , majority of participants were concern about imported cases from neighboring countries , but they were unaware of their contribution for preventing it .
most of participants were unaware of the benefit of their participation in malaria elimination efforts .
participants cited potential barriers include lack of staff at health facilities , location of health facility , and inadequate malaria education , particularly on malaria transmission .
the focus areas for the training have been identified as : information about importance of malaria elimination and community engagement , their role and responsibility , and communication skills .
it was suggested that for involvement community members in activities towards improving their health , regular community meetings could be a way to increase their capacity for engagement in actions .
overall , we found that a large number of people in study area need to understand the benefits of support malaria elimination efforts and attention that is more direct is required to encourage urban residents to involve in malaria activities .
our data also revealed that predisposing , enabling and reinforcing factors associated with community involvement in malaria elimination activities .
our results on predisposing factors are applicable for designing an effective intervention for malaria elimination .
we also found that the main barrier was the gap of knowledge on malaria among respondents because their knowledge on malaria etiology , transmission , and preventions was superficial .
moreover , their attitudes toward involvement in malaria were driven by differences in cultural values and beliefs .
we found lack of knowledge on malaria among young natives , which may due to limited experience ( 3 ) .
therefore , more focus should be on younger residents to increase their involvement in malaria elimination activities .
however , older residents from the native group have demonstrated a better knowledge of malaria causes and symptoms than the other groups .
these findings are in accordance with , which was reported by previous studies ( 21 , 22 , 23 ) .
another important finding of the current study is that participants were unfamiliar with the process of community participation and potential activities , which they could do to improve their health .
therefore , community participation as an opportunity within the neighborhood could improve their trust to achieve malaria elimination goals .
several studies , which were conducted elsewhere , confirmed these findings ( 24 , 25 ) .
results of current study strongly support the need to mobilize community and build community capacity , as it has been suggested already ( 26 , 27 ) . findings reported here addressed some operational needs of the current malaria elimination at the community level in southern malarious areas by assessing factors that might impact future participation of community . it was suggested that we should give more attention to health related cultural beliefs and behaviors .
this study confirms that as a key strategy community participation to eliminate malaria required building capacity in community , and removing socio- cultural barriers . in the light of these results ,
subsequent intervention should strengthen the investment into community participation based on the specific gaps found in the current study .
this research had benefit to national and regional efforts to increase community involvement as a source for effective actions on malaria elimination activities .
ethical issues ( including plagiarism , informed consent , misconduct , data fabrication and/or falsification , double publication and/or submission , etc ) have been completely observed by the authors .
background : this study was undertaken to identify key elements for obtaining community interest and motivate them to support eliminate malaria in the places that malaria is no longer a perceived threat.methods:sequential explanatory mixed methods research design used to provide more comprehensive evidence research . a questionnaire was developed after reviewing the literature relating to community participation for malaria elimination and used to collect data from three native people , iranian migrant and foreign immigrant groups . 
 the variables included access to educational facilities , services , social support , social supporters , trust , and supportive norms were assessed . 
 we also employed an ethnographic design involving : observation participant ( po ) , key informant interviews ( kiis ) , and focus group discussions ( fgds).results : the results revealed that predisposing , enabling and reinforcing factors had association with community involvement . 
 less than 50% of total respondents reported have access to educational sessions , most of them were unaware of available and affordable services . 
 differences views regarding to social support influence have been found among respondents . although patterns of social interactions were almost similar in all residents , frequencies of interactions were varied . 
 three thematic areas emerged including perceptions on involvement , potential barriers , and focus areas for the training community members.conclusion:these findings indicate needs for greater understanding about how to strengthen community involvement with emphasize for community capacity building . 
 this research has benefit to national and regional efforts to increase community involvement as a source for effective actions on malaria elimination .