So we have a direct effect of protection for people who are using bed nets and we also have a community-level effect".
For example, a journal article entitled "Does bar-based, peer-led sexual health promotion have a community-level effect amongst gay men in Scotland?" [ 43] contains both peer education and community engagement concepts.
The initial reference ("key pearl" or "index citation ") (Table 2), identified from the sift process, was "Does bar-based, peer-led sexual health promotion have a community-level effect amongst gay men in Scotland?" [ 43] (See Additional file 2 Directly Relevant Cluster References).
Therefore, an individual level prospective clinical trial is unlikely to capture the community level effect of OEND unless it uses a multisite or social network design or measures community level outcomes to account for the network effects and potential contamination between individual participants.
Second, IRS must be delivered at high coverage since it offers little or no personal protection and since the community level effect of IRS is only achieved at high coverage.
The purpose of this study is to use a multilevel approach to examine individual, establishment and community level effects in a large community-based HIV/AIDS/STI intervention prevention program.
The random-effects method used in this study, in which community level effects have been taken into consideration, finds a more significant association.
These are particularly important because they can detect the 'real life' community level effects of treatment that include possible effects from a reduction in worm transmission (Bundy 2009).
In order to stem intergenerational incarceration and buffer the familial and community level effects of incarceration, future research must examine these higher order outcomes, focusing on how particular intervention and prevention efforts may address incarceration's harmful effects.
Methods for assessing multilevel data [ 22, 23, 25] make it possible to partition individual, establishment and community level effects, thereby allowing researchers to obtain more precise measures of standard errors, resulting in more accurate analysis that takes into account the nested structure of the data.
Nevertheless, a well-designed cost benefit analysis is needed to justify the implementation of any strategy at a community level, because adverse effects and economic cost could exceed the benefits obtained in low fracture risk populations.
