Feasibility of a community-based monitoring system for sexual health in migrants: A comprehensive real-time and post implementation evaluation

Feasibility of a community-based monitoring system for sexual health in migrants: A comprehensive real-time and post implementation evaluation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility of a community-based monitoring system for sexual health in migrants: A comprehensive real-time and post implementation evaluation Constanza Adrian-Parra, Valeria Stuardo-Ávila, Paola Contreras-Hernández, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9440464/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Community-based surveillance in sexual health represents a promising strategy to address the inequalities faced by migrant populations. This study aimed to assess the feasibility of a community-based surveillance system for migrant populations in Chile, considering its acceptability, integration, demand, implementation, and potential for expansion. Methods A qualitative study was conducted based on Bowen’s framework to evaluate the feasibility of the monitoring system during and after its implementation. Follow-up records, interviews, and focus groups with members of community organizations and migrant participants—selected through convenience sampling—were analyzed. A deductive content analysis was performed. Results The monitoring system was highly accepted by both community-based organizations and migrant participants, who emphasized its relevance, capacity to foster reflection, and focus on self-care. Facilitators included the organizations’ capacity to adapt and the technical support provided by the COSMIC team. Identified barriers included limited human and financial resources, weak articulation with primary health care, and operational challenges that required adjustments and reinforcement of community-based strategies. Conclusions The monitoring system proved to be feasible and demonstrated strong potential for scale-up, provided that minimum conditions for sustainability are secured, such as institutional strengthening, stable funding, effective integration with the health system, and reliable detection of vulnerable situations. Feasibility Community-based Surveillance Migrants Sexual Health Implementation Research Figures Figure 1 Contributions to the literature This is among the first feasibility studies of a community-based monitoring system (CBMS) for sexual health targeting migrant populations in Latin America, evaluated through a rigorous implementation research framework. CBS for sexual health proved feasible in highly vulnerable, hard-to-reach populations when delivered through community organizations with gender and human rights expertise, establishing safe and trusted spaces for dialogue in contexts underserved by formal health systems. Structural conditions essential for sustainability and scale-up including stable funding, primary healthcare integration, and intersectional vulnerability assessment tools are identified, with direct implications for public health policy. These findings offer actionable evidence for positioning community-led surveillance as an equitable complement to formal health systems for underserved migrant populations globally. INTRODUCTION A study on the sexual and reproductive health of migrant populations is essential for revealing structural inequalities and barriers to accessing information, prevention, and timely care. Migrant populations often face multiple vulnerability factors—such as precarious living conditions, discrimination, language barriers, and limited knowledge of the health system—that adversely affect their sexual and reproductive well-being [ 1 ]. Using an intersectional approach, sexual health inequalities cannot be understood or addressed from a single dimension. Intersectionality, as reported by Crenshaw [ 2 ] and later expanded within the field of public health, offers a framework for examining how multiple axes of differentiation, such as gender, socioeconomic status, country of origin, migration status, and racialization, intersect to produce complex and specific forms of vulnerability [ 3 ]. In human mobility context, these axes do not operate in isolation; rather, they interact simultaneously, generating structural forms of exclusion that limit access to information, timely care, and safe spaces for decision-making in sexual health. In this scenario, strategies are needed to identify these inequalities early and to generate context-specific evidence to guide public health decision-making. Community-based surveillance (CBS), understood as the systematic detection and reporting of events of public health relevance within a community by its own members[ 4 ], has proven to be effective alternative for monitoring health conditions in hard-to-reach populations or in settings where formal monitoring or surveillance systems face limitations [ 4 ], [ 5 ]. To enhance the effectiveness of these strategies, approaches that support their adaptation and integration into specific contexts are needed. In this regard, implementation research (IR) provides a robust methodological framework for addressing the challenges associated with the deployment of health interventions, as it enables an understanding of how, why, and under what conditions such interventions operate effectively. This approach helps overcome operational barriers and strengthens efforts toward building more efficient, equitable, and sustainable systems [ 6 ]. Moreover, process evaluation is essential for understanding and improving the effectiveness of health interventions [ 6 ], with acceptability and feasibility as key constructs [ 7 ]. According to Sekhon et al. [ 8 ], acceptability “reflects the extent to which people delivering or receiving a health intervention consider it appropriate, based on anticipated or experienced cognitive and emotional responses”, and it comprises seven elements: affective attitude, perceived burden, opportunity costs, ethical acceptability, intervention consistency, perceived effectiveness, and self-efficacy. Feasibility, on the other hand, refers to the extent to which an intervention can be carried out within a given setting. This analysis helps anticipate obstacles, needed adjustments, and conditions for sustainability [ 4 ]. In this regard, feasibility studies proposed by Bowen et al. [ 9 ] address eight key areas: acceptability, demand, implementation, practicality, adaptation, integration, expandability, and preliminary efficacy [ 9 ]. These components are essential for guiding decision-making across the different phases of applied research. This study is part of the COSMIC project (FONDECYT Regular No. 1220371), which aimed to develop a system for monitoring socio-epidemiological and cultural dimentions related to sexual health and associated communicable diseases among migrant populations in Chile. Within this framework, the present study aims to evaluate the feasibility of a community-based monitoring system (CBMS) for migrant populations in Chile, considering its acceptability, integration, demand, implementation, and potential for expansion. Methods Intervention description Between May and November 2024, the CBMS developed by the COSMIC project was implemented in two regional capitals of Chile: Santiago (Metropolitan Region) and Antofagasta (Antofagasta Region). These cities were selected due to their large migrant populations [ 10 ] and the high prevalence of sexually transmitted diseases (STIs). The implementation carried out through five community-based organizations (CBOs), four in Santiago and one in Antofagasta, in coordination with two primary healthcare centers (PHCs), one in each city, to establish a formal linkage between the CBOs and the health system. To monitor the socio-epidemiological dimensions of sexual health, an instrument with specific indicators [ 11 ] and an Individual Vulnerability Index (IVISE) were developed, enabling the identification of highly vulnerable cases and their priority referral to PHC services. Implementation was supported by a digital platform ( www.proyectocosmic.cl ), which allowed real-time monitoring. The lead researcher (CAP) conducted this study as part of her doctoral research. The COSMIC project is led by a multidisciplinary team of academics and technical staff with expertise in public health, gender, and migration health, all of whom had prior experience conducting qualitative studies in similar contexts. Study design A qualitative evaluation study was conducted within an IR framework to assess the acceptability and feasibility of the CBMS. For this purpose, Bowen et al.’s framework [ 9 ], was adopted, as it provides a comprehensive approach to feasibility assessment -incorporating acceptability as a key dimension and serving as the basis for defining analytical categories. This model was complemented with elements from Sekhon et al.’s conceptual framework on acceptability [ 8 ]. The evaluation was carried out in two phases: (i) during the implementation of the CBMS and (ii) after implementation. Analytical categories were defined based on the relevance of the project and objectives of this feasibility assessment. A summary of the main feasibility areas and analytical categories is presented in Table 1 . Table 1 Analysis areas and categories for feasibility assessment during and after intervention according to the Bowen model. Type of analysis Analysis categories During After Acceptability Satisfaction (affective attitude) X X Perceived appropriateness X X Burden X Ethics X X Demand Perception of effectiveness Use of the instrument X X Perceived demand X X Implementation Factors enabling or hindering implementation X Execution level X Amount and type of resources needed for implementation X Integration Positive or negative effects on the institution/organization X X Integration into the organizational culture (self-efficacy) X X Expansion Intention to continue using it X Perceived sustainability X Use of the instrument X Source: Prepared by the authors based on the COSMIC implementation process record. Data collection Secondary and primary data sources were used for data collection. Records from the weekly follow-up meetings with CBOs were systematized to monitor the implementation of the CBMS. In addition, qualitative data collection techniques were applied in two phases using a semi-structured interview and focus group guides (available in supplementary material), both developed on the basis of the Bowen et al. feasibility framework and reviewed and agreed upon by the research team prior to data collection. During the implementation stage (August 2024), one focus group (n = 9 participants) conducted in person and three individual interviews were conducted remotely via videoconferencing conducted remotely via videoconferencing were carried with CBO members. During the post-implementation evaluation (December 2024–January 2025), one group interview (n = 5 participants) with CBO representatives, three individual interviews with CBO volunteers, and five individual interviews with migrant CBMS users were conducted remotely via videoconferencing. Participants were selected through convenience sampling, prioritizing individuals directly involved in the implementation process or beneficiaries of the CBMS. They were recruited through the CBOs participating in the COSMIC project and contacted via the project's established communication channels. All individuals approached agreed to participate, and no withdrawals occurred during the study. All sessions were held in private settings with no third parties present. Methodological triangulation was achieved through the combined use of secondary records, focus groups, and individual interviews. Data triangulation was ensured through the inclusion of three informant types (CBO staff, CBO volunteers, and migrant users) reflecting distinct positions within the implementation process. The deliberate combination of group and individual modalities was aimed at achieving data saturation, group sessions captured collective experiences and organizational dynamics, while individual interviews allowed for in-depth exploration of personal perspectives that may not emerge in group settings. Analysis All interviews and focus groups were conducted by expert personnel, audio-recorded with participants' informed consent and subsequently transcribed for analysis. Transcripts were analyzed using deductive content analysis [ 12 ] was performed by two researchers using ATLAS.ti 23. Each analyst coded (available in supplementary material) the data independently using the predefined feasibility categories derived from the Bowen et al. framework, and discrepancies were resolved through discussion until consensus was reached. Preliminary findings were shared with CBO representatives during a collective validation meeting held in April 2025, where participants reviewed the analysis and provided feedback that was incorporated into the final interpretation of results. Results The feasibility assessment of the CBMS fallowed the identification of institutional conditions that facilitated its implementation, as well as the structural, operational, and contextual challenges encountered. The main findings are presented below and illustrated in Fig. 1 , organized to the key dimensions of Bowen et al.’s framework [ 9 ]: Acceptability COSMIC’s CBMS was highly valued by both CBOs and migrants. CBOs emphasized its contribution to expanding knowledge on sexual health and its usefulness for understanding the everyday impact of social determinants on this population, fostering a more integrated and comprehensive approach. They also noted recognized the system’s potential to attract new users. “We saw there are so many realities during the survey, that it makes you realize how far we are as a society and health system from being able to respond to the needs of the population. The socio-emotional experience of leaving one’s country and working alone, without support networks, is extremely important for migrant populations, yet it is being largely overlooked”. (CBO3) Migrants appreciated the quality of the interactions and the learning process, especially as the CBMS promoted self-reflection and sexual health self-care. Those with higher educational levels noted that their assessment was partly conditioned by the project’s results. “...the interview, in the case, was quite interesting, at least from my viewpoint. It was catchy. So, it makes you eager to answer and to know, to make a self-assessment and tell yourself “I should be more aware of some things.” (MAC32) Adequacy and integration The CBMS was perceived as relevant and aligned with CBOs’ objectives, values and usual CBO processes, especially in their sexual health approach. “... the survey... is directly aligned because it is the way in which CBO works, with a gender approach, with a rights approach...” (CBO2). However, the migrants’ life stories gathered reveal profound structural vulnerabilities, generating ethical concerns and highlighting the need for timely psychosocial support. “...their realities are truly shocking…So, the feeling we have after applying the surveys, we are always in the same place, like, what can we do after that?...” (OBC3) Integrating the CBMS into daily CBO operations required operational adjustments due to the length of the instrument, including dedicated staff or volunteer support, and the refinement of strategies to better engage migrant populations. Internal project socialization facilitated its incorporation into organizational culture and reinforced community-care practices. “The positive aspect is we have been able to continue to convey knowledge… this has also allowed us to grow”. (OBC1) Implementation and demand The implementation of the CBMS revealed varying adaptive capacities among CBOs, largely shaped by their level of human resource consolidation. Material and financial resources support provided by COSMIC facilitated the adoption of strategies tailored to each organization’s needs, which was essential for CBMS implementation and continuity. Three of the five CBOs achieved the expected implementation level, supported by institutional commitment, ongoing technical assistance, and the incorporation of volunteers and interns - although their participation was intermittent due to the absence of contractual ties. “If the agendas were full and the students had not been there, it would not have been possible, I mean, there’s no person in charge of that 24/7, doing the survey...” (OBC2) Several factors hindered implementation. Some CBOs experienced low attendance of migrants, limiting expected coverage -an issue linked to the broader national migration context, marked by stricter administrative policies, anti-migrant rhetoric, and growing institutional distrust. Referral to PHC centers was hampered by territorial misalignment between the designated PHC centers in the COSMIC project and the areas where migrants and CBOs were actually located. Additional challenges included the progressive decline in volunteer participation, technical issues with the COSMIC platform, and limitations in the IVISE’s ability to identify highly intersectional vulnerabilities. These issues were addressed collaboratively by CBOs and the COSMIC team. “...as this project was more demanding, we thought that, in fact, we were going to use more networks in relation to the migrant population than we could generate and there, perhaps, it has been a little more difficult, but we have been able to cope with it as well.” (OBC1) Community representatives noted that the IVISE did not always capture complex vulnerabilities, such as experiences of sexual violence, discrimination based on sexual orientation, or racialized exclusion. Participants emphasized the need to integrate Indicators better aligned with the realities of migrant women and sexually diverse individuals, as well as factors related to support networks, autonomy, and migration regularization. Perceptions of the instrument used to assess vulnerability also differed. CBOs viewed it as extensive and somewhat technical, whereas migrants valued the interview process and the opportunities for dialogue it generated. “For example, if you were raped, if you use some type of contraceptive, if you need help, anything will do, so if this person faces you and asks you those questions, (...) that is, she is a midwife, obviously she is not a psychologist, but she is a professional who can help, she can give you the informationa you need to go somewhere else”. (MSV27) Among the main enabling factors were CBOs’ strong problem-solving capacity and the continuous support of the COSMIC team. In response to initial challenges and low participation, adaptive strategies were incorporated, new organizations joined the process, and community outreach activities were strengthened -measures that improved access and engagement, particularly in high-vulnerability contexts Maintenance and expansion CBOs expressed willingness to continue with using COSMIC’s CBMS, emphasizing its adaptability and potential for expansion to other populations and territories, particularly due to the usefulness of its digital platform for real-time monitoring. “...The only thing we need to continue with COSMIC’s CBMS is to improve some logistical aspects, such as establishing direct referral points to the PHC in different areas of Antofagasta, given its size. Implementing this tool with other key populations would be wonderful, as it is very difficult to obtain specific information about them”. (OBC1) However, long-term sustainability will require strengthening culturally appropriate counseling strategies and securing stable financial support. Participants also stressed the importance of incorporating women and sexually diverse populations, as well as recognizing migration as an intersectional axis of inequality. Discussion The feasibility assessment of the CBMS implemented by COSMIC demonstrated high acceptability among both CBOs and migrant participants. The CBMS created a safe, accessible, and trusted space for addressing sensitive sexual health issues, fostering reflection, promoting self-care, and generating reliable information in contexts where formal health systems have historically failed to reach migrant populations. These findings contribute empirical evidence to an emerging body of literature demonstrating the viability of community-led surveillance for monitoring health conditions in hard-to-reach and structurally excluded populations [ 4 ], [ 5 ], [ 13 ]. The active role of CBOs in identifying barriers and adapting implementation strategies was a key driver of the CBMS's feasibility. The selection of CBOs with expertise in gender and human rights facilitated implementation in settings characterized by multiple and intersecting inequalities, enabling the discussion of sensitive topics, including sexual and reproductive health, social vulnerabilities, and experiences of exclusion, without generating resistance among participants. These findings are consistent with prior research demonstrating that community participation strengthens the legitimacy, relevance, and long-term sustainability of CBS systems [ 14 ], [ 15 ], [ 16 ] [ 17 ]. The operational flexibility of the CBMS implementation process enabled progressive, context-specific adaptations, strengthening system ownership and facilitating strategies to improve access and coverage in areas with initially low migrant participation. Integration of the CBMS into existing CBO routines proved essential for operational continuity. Consistent with evidence highlighting the importance of aligning monitoring systems with community logics and institutional capacities [ 13 ], [ 17 ], this study found that institutional integration prevented duplication of tasks and reinforced organizational culture around community-care practices. Furthermore, the use of a real-time digital monitoring platform strengthened this integration, offering a scalable and adaptable infrastructure for tracking socio-epidemiological trends in sexual health across diverse territorial contexts. Bowen et al.'s framework [ 9 ] provided a comprehensive and analytically robust structure for assessing feasibility across its multiple dimensions. The combination of this framework with Sekhon et al.'s acceptability model [ 8 ] and an IR perspective enriches the methodological toolkit available for evaluating community health interventions. The iterative and participatory approach of IR proved particularly valuable: continuous feedback loops between CBOs and the COSMIC team enabled real-time identification of barriers and facilitated adaptive responses that strengthened the operational feasibility of the system [ 18 ], [ 19 ]. This study thus demonstrates that IR, through iterative processes and ongoing feedback, is particularly well-suited to support the contextual adaptation of CBMS in complex and heterogeneous settings. Despite these strengths and the high acceptability of the CBMS, long-term sustainability faces significant structural barriers. Implementation required financial support from the COSMIC project to some CBOs, internal reorganization within participating organizations, and substantial volunteer involvement, a valuable but inherently unstable resource. This finding reflects the broader structural reality of civil society organizations in Chile, where 44% of income is self-generated, 41% comes from competitive public grants, and only 15% from philanthropic sources [ 20 ], rendering sustainability fragile in the absence of stable, dedicated financing. These conditions underscore that CBMS sustainability cannot rest solely on community commitment; it requires institutional support and reliable funding mechanisms that extend beyond individual project cycles [ 21 ]. Additionally, weak territorial coordination between CBOs and PHC centers, compounded by restrictive migration policies and exclusionary public narratives, negatively affected both migrant attendance at CBOs and the expected functioning of referral pathways to PHC services. These structural determinants of health inequity, widely documented in migrant populations [ 22 ], [ 23 ], directly constrain the effectiveness of community-based interventions and must be addressed systematically for CBS systems to achieve their full public health potential. In this context, advancing towards the expansion of the CBMS requires not only addressing these structural barriers, particularly those related to strengthening funding, human resources, and intersectoral coordination, but also reinforcing the monitoring mechanisms already in place. It is essential to deepen the evaluation of the IVISE and strengthen its intersectional approach to more accurately identify high-vulnerability situations, particularly among migrant women whose experiences are shaped by multiple and overlapping forms of exclusion (24,25). This represents both a methodological priority and a matter of health equity that should guide future iterations of the system [ 24 ], [ 25 ]. This study has several limitations. The use of convenience sampling, focused on individuals directly involved with the CBMS, may have resulted in more favorable assessments and restricts the generalizability of the findings. The evaluation was conducted during the initial phase of the CBMS, which limits conclusions about the long-term sustainability of the system. Furthermore, while institutional coordination was explored from the perspective of CBOs, the participation of PHC professionals was limited. Despite these limitations, the study has important strengths. The two-phase evaluation design, combining real-time and post-implementation data within a theoretically grounded framework, provided a comprehensive and dynamic picture of feasibility across multiple dimensions. The integration of community voices through focus groups, individual interviews, and participatory feedback mechanisms strengthened the contextual relevance and trustworthiness of the findings, while the collective validation processes employed throughout the study contributed to mitigating biases associated with researcher positionality. Conclusions The CBMS proved to be a feasible and well-accepted strategy for addressing sexual health among migrant populations. Its long-term sustainability will depend on institutional strengthening and stable financing. The active involvement of CBOs was essential for achieving territorial relevance, legitimacy, and effectiveness. By adopting a community-centered approach, the CBMS was able to identify and address complex vulnerabilities, promoting self-care and trust in contexts that are often insufficiently reached by the formal health system. Abbreviations CBS Community-Based Surveillance CBMS Community-Based Monitoring System CBO(s) Community-Based Organization(s) COSMIC Community-Based Surveillance of Socio-Epidemiological Aspects Linked to Sexual Health and Related Communicable Diseases in the Migrant Population in Chile FONDECYT Fondo Nacional de Desarrollo Científico y Tecnológico (National Fund for Scientific and Technological Development, Chile) IR Implementation Research IVISE Individual Socio-Epidemiological Vulnerability Index PHC Primary Health Care STIs Sexually Transmitted Infections Declarations Ethics approval and consent to participate All procedures were performed in accordance with the ethical standards of the Declaration of Helsinki (2013 revision) and with the Chilean regulations governing research with human subjects (Law No. 20.120). This project was approved through Act No. 017/2022, of May 10, by the Bioethics Committee of the Vice-Rectorate for Research and Doctoral Programs of the Andrés Bello University, and by the Scientific Ethics Committees of the North Metropolitan Health Service (No. 022/2023) and the Antofagasta Health Service (No. 038-23/2024). Informed consent was obtained from all subjects involved in the study. Consent for publication Not Applicable. Availability of data and materials The data that support the findings of this study (including interview transcripts, focus group records, and implementation follow-up documents) are not publicly available due to ethical restrictions and the confidentiality of participant information. The interview and focus group guides, as well as the coding tree used for the analysis, are available as supplementary material to this article. Access to anonymized data may be considered upon reasonable request to the corresponding author.. Competing interests The authors declare no conflicts of interest. Funding This work was conducted as part of the COSMIC project, “Community-based surveillance of social epidemiological aspects linked to sexual health and related communicable diseases among the migrant population in Chile,” funded by the National Agency for Research and Development of Chile and the National Fund for Scientific and Technological Development (ANID)(Fondecyt Regular 1220371). Authors' contributions Conceptualization: VSA, PCH, CAP, MCP, CBI, , CLD Methodology: CAP, VSA, PCH, KLA. Formal analysis and investigation: CAP, KLA, CLD, MCP, CBI Support in data collection for research: KLA, CAP, CLD, EC, DD, DS, CB, CLV, MCP, CBI Writing - original draft preparation: CAP. Writing - review and editing: All Authors Funding acquisition: VSA. Acknowledgments The authors gratefully acknowledge ANID, Chile, for funding the COSMIC project. 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Supplementary Files SupplementaryMaterialCOSMICVIABILIDAD.docx COREQChecklistCOSMIC.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers agreed at journal 05 May, 2026 Reviews received at journal 05 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviewers agreed at journal 03 May, 2026 Reviewers agreed at journal 01 May, 2026 Reviewers invited by journal 01 May, 2026 Editor assigned by journal 23 Apr, 2026 Submission checks completed at journal 23 Apr, 2026 First submitted to journal 16 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9440464","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635944775,"identity":"54aa184e-289c-474a-b4ba-d72a43859bb7","order_by":0,"name":"Constanza Adrian-Parra","email":"","orcid":"","institution":"Millennium Nucleus on Community-Based Research and Inequalities in Sexual Health (DIBASS)","correspondingAuthor":false,"prefix":"","firstName":"Constanza","middleName":"","lastName":"Adrian-Parra","suffix":""},{"id":635944776,"identity":"646a2d83-e117-47c5-988b-15753d88394f","order_by":1,"name":"Valeria Stuardo-Ávila","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYFAC5gYGBgMYh41BDkwyMFjg0cII1cIG0WIMZUoQ0MKA0JLYQEiLwfGDjY8rCuwY5Of3GH6uKLNJ33C7+dkDhho8Ws4kNhueMUhmMDjGYyx55lxa7oY7x8wNGI7h1iLZkNgm2WDAzGDAxmMg2dh2OHfDjQQzCcYGPFr6H7b/bDCoZ5Bv4zH+CdSSbnAj/RteLfwSiW2MDQaHGRiO8ZiBbEkwuJGD3xZ+iYfNQIcd5zE4llZm2XAuzXDmjZxygwQ8fmHjTz74seFPtZx88+HNNxvKbOT5bqRve/ChxganFhjgQeUmENQwCkbBKBgFowAfAAArbk7NOOEnAQAAAABJRU5ErkJggg==","orcid":"","institution":"Universidad Andrés Bello","correspondingAuthor":true,"prefix":"","firstName":"Valeria","middleName":"","lastName":"Stuardo-Ávila","suffix":""},{"id":635944779,"identity":"8a365966-0901-4823-91fc-076aef8f9f2a","order_by":2,"name":"Paola Contreras-Hernández","email":"","orcid":"","institution":"University of Viña del Mar","correspondingAuthor":false,"prefix":"","firstName":"Paola","middleName":"","lastName":"Contreras-Hernández","suffix":""},{"id":635944786,"identity":"78054d1d-0fd8-4361-aaef-eb1672dfb705","order_by":3,"name":"Kenny Low-Andrade","email":"","orcid":"","institution":"Independent researcher","correspondingAuthor":false,"prefix":"","firstName":"Kenny","middleName":"","lastName":"Low-Andrade","suffix":""},{"id":635944787,"identity":"6645b144-2a1b-4761-8725-c1ad6895d758","order_by":4,"name":"Cristian Lisboa-Donoso","email":"","orcid":"","institution":"San Sebastian University","correspondingAuthor":false,"prefix":"","firstName":"Cristian","middleName":"","lastName":"Lisboa-Donoso","suffix":""},{"id":635944792,"identity":"986cfa87-7316-4d11-8d0e-8662277dab30","order_by":5,"name":"Carlos Becerra","email":"","orcid":"","institution":"AIDS Healthcare 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Center","correspondingAuthor":false,"prefix":"","firstName":"Evelyn","middleName":"","lastName":"Cortés","suffix":""},{"id":635944803,"identity":"767a313f-d97b-43a0-8a7d-fe878f669899","order_by":9,"name":"Carlos Lobos Vega","email":"","orcid":"","institution":"Fundación Chile Positivo","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"Lobos","lastName":"Vega","suffix":""},{"id":635944804,"identity":"92daab19-8019-4d9b-b950-33f6aadb983b","order_by":10,"name":"Mercedes Carrasco-Portiño","email":"","orcid":"","institution":"Universidad de Concepción","correspondingAuthor":false,"prefix":"","firstName":"Mercedes","middleName":"","lastName":"Carrasco-Portiño","suffix":""},{"id":635944805,"identity":"cd2008c6-5063-46ab-bd99-3becbb720965","order_by":11,"name":"Cecilia Bustos-Ibarra","email":"","orcid":"","institution":"Universidad de Concepción","correspondingAuthor":false,"prefix":"","firstName":"Cecilia","middleName":"","lastName":"Bustos-Ibarra","suffix":""}],"badges":[],"createdAt":"2026-04-16 16:10:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9440464/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9440464/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108974459,"identity":"8117b4b0-cbee-4503-8c1e-5b9ea6b38fcc","added_by":"auto","created_at":"2026-05-11 10:51:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":265998,"visible":true,"origin":"","legend":"\u003cp\u003eFeasibility assessment finding\u003c/p\u003e","description":"","filename":"Figure1.Feasibilityassessmentfindings.png","url":"https://assets-eu.researchsquare.com/files/rs-9440464/v1/a77b7d64b74f156c8889ede4.png"},{"id":109202462,"identity":"797bc5c2-7bc0-4be1-b0e5-2ae4f4ae4b0e","added_by":"auto","created_at":"2026-05-13 14:04:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":619517,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9440464/v1/75047782-5b3e-4061-9920-3395414acbcf.pdf"},{"id":108974461,"identity":"1ac74498-195f-4634-98ab-3420999e7515","added_by":"auto","created_at":"2026-05-11 10:51:25","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":48355,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialCOSMICVIABILIDAD.docx","url":"https://assets-eu.researchsquare.com/files/rs-9440464/v1/47934ce302342cf8d9e5ef43.docx"},{"id":108974460,"identity":"1b6f0377-341e-4e20-a75f-1ced73bdd432","added_by":"auto","created_at":"2026-05-11 10:51:25","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":379342,"visible":true,"origin":"","legend":"","description":"","filename":"COREQChecklistCOSMIC.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9440464/v1/30f851d585e1ce9791ee9e4c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Feasibility of a community-based monitoring system for sexual health in migrants: A comprehensive real-time and post implementation evaluation","fulltext":[{"header":"Contributions to the literature","content":"\u003cul\u003e\n \u003cli\u003eThis is among the first feasibility studies of a community-based monitoring system (CBMS) for sexual health targeting migrant populations in Latin America, evaluated through a rigorous implementation research framework.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCBS for sexual health proved feasible in highly vulnerable, hard-to-reach populations when delivered through community organizations with gender and human rights expertise, establishing safe and trusted spaces for dialogue in contexts underserved by formal health systems.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eStructural conditions essential for sustainability and scale-up including stable funding, primary healthcare integration, and intersectional vulnerability assessment tools are identified, with direct implications for public health policy.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThese findings offer actionable evidence for positioning community-led surveillance as an equitable complement to formal health systems for underserved migrant populations globally.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eA study on the sexual and reproductive health of migrant populations is essential for revealing structural inequalities and barriers to accessing information, prevention, and timely care. Migrant populations often face multiple vulnerability factors\u0026mdash;such as precarious living conditions, discrimination, language barriers, and limited knowledge of the health system\u0026mdash;that adversely affect their sexual and reproductive well-being [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Using an intersectional approach, sexual health inequalities cannot be understood or addressed from a single dimension. Intersectionality, as reported by Crenshaw [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and later expanded within the field of public health, offers a framework for examining how multiple axes of differentiation, such as gender, socioeconomic status, country of origin, migration status, and racialization, intersect to produce complex and specific forms of vulnerability [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In human mobility context, these axes do not operate in isolation; rather, they interact simultaneously, generating structural forms of exclusion that limit access to information, timely care, and safe spaces for decision-making in sexual health.\u003c/p\u003e \u003cp\u003eIn this scenario, strategies are needed to identify these inequalities early and to generate context-specific evidence to guide public health decision-making. Community-based surveillance (CBS), understood as the systematic detection and reporting of events of public health relevance within a community by its own members[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], has proven to be effective alternative for monitoring health conditions in hard-to-reach populations or in settings where formal monitoring or surveillance systems face limitations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo enhance the effectiveness of these strategies, approaches that support their adaptation and integration into specific contexts are needed. In this regard, implementation research (IR) provides a robust methodological framework for addressing the challenges associated with the deployment of health interventions, as it enables an understanding of how, why, and under what conditions such interventions operate effectively. This approach helps overcome operational barriers and strengthens efforts toward building more efficient, equitable, and sustainable systems [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, process evaluation is essential for understanding and improving the effectiveness of health interventions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], with acceptability and feasibility as key constructs [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. According to Sekhon et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], acceptability \u0026ldquo;reflects the extent to which people delivering or receiving a health intervention consider it appropriate, based on anticipated or experienced cognitive and emotional responses\u0026rdquo;, and it comprises seven elements: affective attitude, perceived burden, opportunity costs, ethical acceptability, intervention consistency, perceived effectiveness, and self-efficacy.\u003c/p\u003e \u003cp\u003eFeasibility, on the other hand, refers to the extent to which an intervention can be carried out within a given setting. This analysis helps anticipate obstacles, needed adjustments, and conditions for sustainability [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In this regard, feasibility studies proposed by Bowen et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] address eight key areas: acceptability, demand, implementation, practicality, adaptation, integration, expandability, and preliminary efficacy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These components are essential for guiding decision-making across the different phases of applied research.\u003c/p\u003e \u003cp\u003eThis study is part of the COSMIC project (FONDECYT Regular No. 1220371), which aimed to develop a system for monitoring socio-epidemiological and cultural dimentions related to sexual health and associated communicable diseases among migrant populations in Chile. Within this framework, the present study aims to evaluate the feasibility of a community-based monitoring system (CBMS) for migrant populations in Chile, considering its acceptability, integration, demand, implementation, and potential for expansion.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eIntervention description \u003c/p\u003e\u003cp\u003e Between May and November 2024, the CBMS developed by the COSMIC project was implemented in two regional capitals of Chile: Santiago (Metropolitan Region) and Antofagasta (Antofagasta Region). These cities were selected due to their large migrant populations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and the high prevalence of sexually transmitted diseases (STIs). The implementation carried out through five community-based organizations (CBOs), four in Santiago and one in Antofagasta, in coordination with two primary healthcare centers (PHCs), one in each city, to establish a formal linkage between the CBOs and the health system.\u003c/p\u003e \u003cp\u003eTo monitor the socio-epidemiological dimensions of sexual health, an instrument with specific indicators [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and an Individual Vulnerability Index (IVISE) were developed, enabling the identification of highly vulnerable cases and their priority referral to PHC services. Implementation was supported by a digital platform (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.proyectocosmic.cl\u003c/span\u003e\u003cspan address=\"http://www.proyectocosmic.cl\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), which allowed real-time monitoring.\u003c/p\u003e \u003cp\u003eThe lead researcher (CAP) conducted this study as part of her doctoral research. The COSMIC project is led by a multidisciplinary team of academics and technical staff with expertise in public health, gender, and migration health, all of whom had prior experience conducting qualitative studies in similar contexts.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA qualitative evaluation study was conducted within an IR framework to assess the acceptability and feasibility of the CBMS. For this purpose, Bowen et al.\u0026rsquo;s framework [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], was adopted, as it provides a comprehensive approach to feasibility assessment -incorporating acceptability as a key dimension and serving as the basis for defining analytical categories. This model was complemented with elements from Sekhon \u003cem\u003eet al.\u0026rsquo;s\u003c/em\u003e conceptual framework on acceptability [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe evaluation was carried out in two phases: (i) during the implementation of the CBMS and (ii) after implementation. Analytical categories were defined based on the relevance of the project and objectives of this feasibility assessment.\u003c/p\u003e \u003cp\u003eA summary of the main feasibility areas and analytical categories is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis areas and categories for feasibility assessment during and after intervention according to the Bowen model.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnalysis categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDuring\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAfter\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAcceptability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSatisfaction (affective attitude)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived appropriateness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDemand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerception of effectiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of the instrument\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eImplementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactors enabling or hindering implementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExecution level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmount and type of resources needed for implementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIntegration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive or negative effects on the institution/organization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntegration into the organizational culture (self-efficacy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eExpansion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntention to continue using it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived sustainability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of the instrument\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSource: Prepared by the authors based on the COSMIC implementation process record.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eSecondary and primary data sources were used for data collection. Records from the weekly follow-up meetings with CBOs were systematized to monitor the implementation of the CBMS. In addition, qualitative data collection techniques were applied in two phases using a semi-structured interview and focus group guides (available in supplementary material), both developed on the basis of the Bowen et al. feasibility framework and reviewed and agreed upon by the research team prior to data collection. During the implementation stage (August 2024), one focus group (n\u0026thinsp;=\u0026thinsp;9 participants) conducted in person and three individual interviews were conducted remotely via videoconferencing conducted remotely via videoconferencing were carried with CBO members. During the post-implementation evaluation (December 2024\u0026ndash;January 2025), one group interview (n\u0026thinsp;=\u0026thinsp;5 participants) with CBO representatives, three individual interviews with CBO volunteers, and five individual interviews with migrant CBMS users were conducted remotely via videoconferencing.\u003c/p\u003e \u003cp\u003eParticipants were selected through convenience sampling, prioritizing individuals directly involved in the implementation process or beneficiaries of the CBMS. They were recruited through the CBOs participating in the COSMIC project and contacted via the project's established communication channels. All individuals approached agreed to participate, and no withdrawals occurred during the study. All sessions were held in private settings with no third parties present.\u003c/p\u003e \u003cp\u003eMethodological triangulation was achieved through the combined use of secondary records, focus groups, and individual interviews. Data triangulation was ensured through the inclusion of three informant types (CBO staff, CBO volunteers, and migrant users) reflecting distinct positions within the implementation process. The deliberate combination of group and individual modalities was aimed at achieving data saturation, group sessions captured collective experiences and organizational dynamics, while individual interviews allowed for in-depth exploration of personal perspectives that may not emerge in group settings.\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eAll interviews and focus groups were conducted by expert personnel, audio-recorded with participants' informed consent and subsequently transcribed for analysis. Transcripts were analyzed using deductive content analysis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] was performed by two researchers using ATLAS.ti 23. Each analyst coded (available in supplementary material) the data independently using the predefined feasibility categories derived from the Bowen et al. framework, and discrepancies were resolved through discussion until consensus was reached.\u003c/p\u003e \u003cp\u003ePreliminary findings were shared with CBO representatives during a collective validation meeting held in April 2025, where participants reviewed the analysis and provided feedback that was incorporated into the final interpretation of results.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe feasibility assessment of the CBMS fallowed the identification of institutional conditions that facilitated its implementation, as well as the structural, operational, and contextual challenges encountered. The main findings are presented below and illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, organized to the key dimensions of Bowen \u003cem\u003eet al.\u0026rsquo;s\u003c/em\u003e framework [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eAcceptability\u003c/h3\u003e\n\u003cp\u003eCOSMIC\u0026rsquo;s CBMS was highly valued by both CBOs and migrants. CBOs emphasized its contribution to expanding knowledge on sexual health and its usefulness for understanding the everyday impact of social determinants on this population, fostering a more integrated and comprehensive approach. They also noted recognized the system\u0026rsquo;s potential to attract new users.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;We saw there are so many realities during the survey, that it makes you realize how far we are as a society and health system from being able to respond to the needs of the population. The socio-emotional experience of leaving one\u0026rsquo;s country and working alone, without support networks, is extremely important for migrant populations, yet it is being largely overlooked\u0026rdquo;.\u003c/em\u003e (CBO3)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eMigrants appreciated the quality of the interactions and the learning process, especially as the CBMS promoted self-reflection and sexual health self-care. Those with higher educational levels noted that their assessment was partly conditioned by the project\u0026rsquo;s results.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;...the interview, in the case, was quite interesting, at least from my viewpoint. It was catchy. So, it makes you eager to answer and to know, to make a self-assessment and tell yourself \u0026ldquo;I should be more aware of some things.\u0026rdquo;\u003c/em\u003e (MAC32)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAdequacy and integration\u003c/h2\u003e \u003cp\u003eThe CBMS was perceived as relevant and aligned with CBOs\u0026rsquo; objectives, values and usual CBO processes, especially in their sexual health approach.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;... the survey... is directly aligned because it is the way in which CBO works, with a gender approach, with a rights approach...\u0026rdquo;\u003c/em\u003e (CBO2).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, the migrants\u0026rsquo; life stories gathered reveal profound structural vulnerabilities, generating ethical concerns and highlighting the need for timely psychosocial support.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;...their realities are truly shocking\u0026hellip;So, the feeling we have after applying the surveys, we are always in the same place, like, what can we do after that?...\u0026rdquo;\u003c/em\u003e (OBC3)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIntegrating the CBMS into daily CBO operations required operational adjustments due to the length of the instrument, including dedicated staff or volunteer support, and the refinement of strategies to better engage migrant populations. Internal project socialization facilitated its incorporation into organizational culture and reinforced community-care practices.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The positive aspect is we have been able to continue to convey knowledge\u0026hellip; this has also allowed us to grow\u0026rdquo;.\u003c/em\u003e (OBC1)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eImplementation and demand\u003c/h3\u003e\n\u003cp\u003eThe implementation of the CBMS revealed varying adaptive capacities among CBOs, largely shaped by their level of human resource consolidation. Material and financial resources support provided by COSMIC facilitated the adoption of strategies tailored to each organization\u0026rsquo;s needs, which was essential for CBMS implementation and continuity. Three of the five CBOs achieved the expected implementation level, supported by institutional commitment, ongoing technical assistance, and the incorporation of volunteers and interns - although their participation was intermittent due to the absence of contractual ties.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;If the agendas were full and the students had not been there, it would not have been possible, I mean, there\u0026rsquo;s no person in charge of that 24/7, doing the survey...\u0026rdquo;\u003c/em\u003e (OBC2)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSeveral factors hindered implementation. Some CBOs experienced low attendance of migrants, limiting expected coverage -an issue linked to the broader national migration context, marked by stricter administrative policies, anti-migrant rhetoric, and growing institutional distrust. Referral to PHC centers was hampered by territorial misalignment between the designated PHC centers in the COSMIC project and the areas where migrants and CBOs were actually located. Additional challenges included the progressive decline in volunteer participation, technical issues with the COSMIC platform, and limitations in the IVISE\u0026rsquo;s ability to identify highly intersectional vulnerabilities. These issues were addressed collaboratively by CBOs and the COSMIC team.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;...as this project was more demanding, we thought that, in fact, we were going to use more networks in relation to the migrant population than we could generate and there, perhaps, it has been a little more difficult, but we have been able to cope with it as well.\u0026rdquo;\u003c/em\u003e (OBC1)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eCommunity representatives noted that the IVISE did not always capture complex vulnerabilities, such as experiences of sexual violence, discrimination based on sexual orientation, or racialized exclusion. Participants emphasized the need to integrate Indicators better aligned with the realities of migrant women and sexually diverse individuals, as well as factors related to support networks, autonomy, and migration regularization.\u003c/p\u003e \u003cp\u003ePerceptions of the instrument used to assess vulnerability also differed. CBOs viewed it as extensive and somewhat technical, whereas migrants valued the interview process and the opportunities for dialogue it generated.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;For example, if you were raped, if you use some type of contraceptive, if you need help, anything will do, so if this person faces you and asks you those questions, (...) that is, she is a midwife, obviously she is not a psychologist, but she is a professional who can help, she can give you the informationa you need to go somewhere else\u0026rdquo;.\u003c/em\u003e (MSV27)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAmong the main enabling factors were CBOs\u0026rsquo; strong problem-solving capacity and the continuous support of the COSMIC team. In response to initial challenges and low participation, adaptive strategies were incorporated, new organizations joined the process, and community outreach activities were strengthened -measures that improved access and engagement, particularly in high-vulnerability contexts\u003c/p\u003e\n\u003ch3\u003eMaintenance and expansion\u003c/h3\u003e\n\u003cp\u003eCBOs expressed willingness to continue with using COSMIC\u0026rsquo;s CBMS, emphasizing its adaptability and potential for expansion to other populations and territories, particularly due to the usefulness of its digital platform for real-time monitoring.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;...The only thing we need to continue with COSMIC\u0026rsquo;s CBMS is to improve some logistical aspects, such as establishing direct referral points to the PHC in different areas of Antofagasta, given its size. Implementing this tool with other key populations would be wonderful, as it is very difficult to obtain specific information about them\u0026rdquo;.\u003c/em\u003e (OBC1)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, long-term sustainability will require strengthening culturally appropriate counseling strategies and securing stable financial support. Participants also stressed the importance of incorporating women and sexually diverse populations, as well as recognizing migration as an intersectional axis of inequality.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e The feasibility assessment of the CBMS implemented by COSMIC demonstrated high acceptability among both CBOs and migrant participants. The CBMS created a safe, accessible, and trusted space for addressing sensitive sexual health issues, fostering reflection, promoting self-care, and generating reliable information in contexts where formal health systems have historically failed to reach migrant populations. These findings contribute empirical evidence to an emerging body of literature demonstrating the viability of community-led surveillance for monitoring health conditions in hard-to-reach and structurally excluded populations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe active role of CBOs in identifying barriers and adapting implementation strategies was a key driver of the CBMS's feasibility. The selection of CBOs with expertise in gender and human rights facilitated implementation in settings characterized by multiple and intersecting inequalities, enabling the discussion of sensitive topics, including sexual and reproductive health, social vulnerabilities, and experiences of exclusion, without generating resistance among participants. These findings are consistent with prior research demonstrating that community participation strengthens the legitimacy, relevance, and long-term sustainability of CBS systems [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The operational flexibility of the CBMS implementation process enabled progressive, context-specific adaptations, strengthening system ownership and facilitating strategies to improve access and coverage in areas with initially low migrant participation.\u003c/p\u003e \u003cp\u003eIntegration of the CBMS into existing CBO routines proved essential for operational continuity. Consistent with evidence highlighting the importance of aligning monitoring systems with community logics and institutional capacities [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], this study found that institutional integration prevented duplication of tasks and reinforced organizational culture around community-care practices. Furthermore, the use of a real-time digital monitoring platform strengthened this integration, offering a scalable and adaptable infrastructure for tracking socio-epidemiological trends in sexual health across diverse territorial contexts.\u003c/p\u003e \u003cp\u003eBowen et al.'s framework [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] provided a comprehensive and analytically robust structure for assessing feasibility across its multiple dimensions. The combination of this framework with Sekhon et al.'s acceptability model [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and an IR perspective enriches the methodological toolkit available for evaluating community health interventions. The iterative and participatory approach of IR proved particularly valuable: continuous feedback loops between CBOs and the COSMIC team enabled real-time identification of barriers and facilitated adaptive responses that strengthened the operational feasibility of the system [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This study thus demonstrates that IR, through iterative processes and ongoing feedback, is particularly well-suited to support the contextual adaptation of CBMS in complex and heterogeneous settings.\u003c/p\u003e \u003cp\u003eDespite these strengths and the high acceptability of the CBMS, long-term sustainability faces significant structural barriers. Implementation required financial support from the COSMIC project to some CBOs, internal reorganization within participating organizations, and substantial volunteer involvement, a valuable but inherently unstable resource. This finding reflects the broader structural reality of civil society organizations in Chile, where 44% of income is self-generated, 41% comes from competitive public grants, and only 15% from philanthropic sources [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], rendering sustainability fragile in the absence of stable, dedicated financing. These conditions underscore that CBMS sustainability cannot rest solely on community commitment; it requires institutional support and reliable funding mechanisms that extend beyond individual project cycles [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Additionally, weak territorial coordination between CBOs and PHC centers, compounded by restrictive migration policies and exclusionary public narratives, negatively affected both migrant attendance at CBOs and the expected functioning of referral pathways to PHC services. These structural determinants of health inequity, widely documented in migrant populations [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], directly constrain the effectiveness of community-based interventions and must be addressed systematically for CBS systems to achieve their full public health potential.\u003c/p\u003e \u003cp\u003eIn this context, advancing towards the expansion of the CBMS requires not only addressing these structural barriers, particularly those related to strengthening funding, human resources, and intersectoral coordination, but also reinforcing the monitoring mechanisms already in place. It is essential to deepen the evaluation of the IVISE and strengthen its intersectional approach to more accurately identify high-vulnerability situations, particularly among migrant women whose experiences are shaped by multiple and overlapping forms of exclusion (24,25). This represents both a methodological priority and a matter of health equity that should guide future iterations of the system [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has several limitations. The use of convenience sampling, focused on individuals directly involved with the CBMS, may have resulted in more favorable assessments and restricts the generalizability of the findings. The evaluation was conducted during the initial phase of the CBMS, which limits conclusions about the long-term sustainability of the system. Furthermore, while institutional coordination was explored from the perspective of CBOs, the participation of PHC professionals was limited. Despite these limitations, the study has important strengths. The two-phase evaluation design, combining real-time and post-implementation data within a theoretically grounded framework, provided a comprehensive and dynamic picture of feasibility across multiple dimensions. The integration of community voices through focus groups, individual interviews, and participatory feedback mechanisms strengthened the contextual relevance and trustworthiness of the findings, while the collective validation processes employed throughout the study contributed to mitigating biases associated with researcher positionality.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe CBMS proved to be a feasible and well-accepted strategy for addressing sexual health among migrant populations. Its long-term sustainability will depend on institutional strengthening and stable financing. The active involvement of CBOs was essential for achieving territorial relevance, legitimacy, and effectiveness. By adopting a community-centered approach, the CBMS was able to identify and address complex vulnerabilities, promoting self-care and trust in contexts that are often insufficiently reached by the formal health system.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity-Based Surveillance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity-Based Monitoring System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBO(s)\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity-Based Organization(s)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOSMIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity-Based Surveillance of Socio-Epidemiological Aspects Linked to Sexual Health and Related Communicable Diseases in the Migrant Population in Chile\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFONDECYT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFondo Nacional de Desarrollo Cient\u0026iacute;fico y Tecnol\u0026oacute;gico (National Fund for Scientific and Technological Development, Chile)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eImplementation Research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIVISE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIndividual Socio-Epidemiological Vulnerability Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrimary Health Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTIs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexually Transmitted Infections\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eAll procedures were performed in accordance with the ethical standards of the Declaration of Helsinki (2013 revision) and with the Chilean regulations governing research with human subjects (Law No. 20.120). This project was approved through Act No. 017/2022, of May 10, by the Bioethics Committee of the Vice-Rectorate for Research and Doctoral Programs of the Andrés Bello University, and by the Scientific Ethics Committees of the North Metropolitan Health Service (No. 022/2023) and the Antofagasta Health Service (No. 038-23/2024). Informed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study (including interview transcripts, focus group records, and implementation follow-up documents) are not publicly available due to ethical restrictions and the confidentiality of participant information. The interview and focus group guides, as well as the coding tree used for the analysis, are available as supplementary material to this article. Access to anonymized data may be considered upon reasonable request to the corresponding author..\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work was conducted as part of the COSMIC project, “Community-based surveillance of social epidemiological aspects linked to sexual health and related communicable diseases among the migrant population in Chile,” funded by the National Agency for Research and Development of Chile and the National Fund for Scientific and Technological Development (ANID)(Fondecyt Regular 1220371).\u003c/p\u003e\n\u003cp\u003eAuthors' contributions\u003c/p\u003e\n\u003cp\u003eConceptualization: VSA, PCH, CAP, MCP, CBI, , CLD\u003c/p\u003e\n\u003cp\u003eMethodology: CAP, VSA, PCH, KLA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFormal analysis and investigation: CAP, KLA, CLD, MCP, CBI\u003c/p\u003e\n\u003cp\u003eSupport in data collection for research: KLA, CAP, CLD, EC, DD, DS, CB, CLV, MCP, CBI\u003c/p\u003e\n\u003cp\u003eWriting - original draft preparation: CAP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting - review and editing: All Authors\u003c/p\u003e\n\u003cp\u003eFunding acquisition: VSA.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge ANID, Chile, for funding the COSMIC project. We also would like to thank all those who contributed to the development of this monitoring system, especially community workers and migrants who generously shared their life stories.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eD. Egli-Gany \u003cem\u003eet al.\u003c/em\u003e, \u0026laquo;The social and structural determinants of sexual and reproductive health and rights in migrants and refugees: a systematic review of reviews.\u0026raquo;, \u003cem\u003eEast. Mediterr. Health J.\u003c/em\u003e, vol. 27, n.\u003csup\u003eo\u003c/sup\u003e 12, Art. n.\u003csup\u003eo\u003c/sup\u003e 12, dic. 2021.\u003c/li\u003e\n\u003cli\u003eK. Crenshaw, \u0026laquo;Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics\u0026raquo;, \u003cem\u003eU Chi Leg. F\u003c/em\u003e, vol. 1989, p. 139, ene. 1989.\u003c/li\u003e\n\u003cli\u003eN. L\u0026oacute;pez y V. L. 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[En l\u0026iacute;nea]. Disponible en: https://www.ifrc.org/document/community-based-surveillance-guiding-principles\u003c/li\u003e\n\u003cli\u003eS. Theobald \u003cem\u003eet al.\u003c/em\u003e, \u0026laquo;Implementation research: new imperatives and opportunities in global health\u0026raquo;, \u003cem\u003eThe Lancet\u003c/em\u003e, vol. 392, n.\u003csup\u003eo\u003c/sup\u003e 10160, pp. 2214-2228, nov. 2018, doi: 10.1016/S0140-6736(18)32205-0.\u003c/li\u003e\n\u003cli\u003eDavid H. Peters, Nhan T. Tran, Taghreed Adam, \u0026laquo;Implementation Research in Health: A Practical Guide.\u0026raquo;, Alliance for Health Policy and Systems Research, World Health Organization, 2013. Accedido: 4 de mayo de 2024. [En l\u0026iacute;nea]. Disponible en: https://ahpsr.who.int/publications/i/item/9789241506212\u003c/li\u003e\n\u003cli\u003eM. Sekhon, M. Cartwright, y J. J. Francis, \u0026laquo;Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework\u0026raquo;, \u003cem\u003eBMC Health Serv. Res.\u003c/em\u003e, vol. 17, n.\u003csup\u003eo\u003c/sup\u003e 1, p. 88, ene. 2017, doi: 10.1186/s12913-017-2031-8.\u003c/li\u003e\n\u003cli\u003eD. J. Bowen \u003cem\u003eet al.\u003c/em\u003e, \u0026laquo;How we design feasibility studies\u0026raquo;, \u003cem\u003eAm. J. Prev. Med.\u003c/em\u003e, vol. 36, n.\u003csup\u003eo\u003c/sup\u003e 5, pp. 452-457, may 2009, doi: 10.1016/j.amepre.2009.02.002.\u003c/li\u003e\n\u003cli\u003eInstituto Nacional de Estad\u0026iacute;sticas (INE), \u0026laquo;Informe de resultados de la estimaci\u0026oacute;n de personas extranjeras a diciembre del a\u0026ntilde;o 2023\u0026raquo;, dic. 2024. [En l\u0026iacute;nea]. Disponible en: https://www.ine.gob.cl/docs/default-source/demografia-y-migracion/publicaciones-y-anuarios/migraci%C3%B3n-internacional/estimaci%C3%B3n-poblaci%C3%B3n-extranjera-en-chile-2018/informe-resultados-epe2023.pdf?sfvrsn=91b95f6f_8\u003c/li\u003e\n\u003cli\u003eC. Adrian Parra \u003cem\u003eet al.\u003c/em\u003e, \u0026laquo;Developing socio-epidemiological indicators of sexual health among migrant population in Chile\u0026raquo;, \u003cem\u003eArch. \u003c/em\u003e\u003cem\u003ePublic Health\u003c/em\u003e, vol. 83, n.\u003csup\u003eo\u003c/sup\u003e 1, p. 98, abr. 2025, doi: 10.1186/s13690-025-01587-3.\u003c/li\u003e\n\u003cli\u003eJ. Valverde y C. Lozares, \u0026laquo;Cap\u0026iacute;tulo 2: Las estrategias metodol\u0026oacute;gicas en la investigaci\u0026oacute;n cualitativa\u0026raquo;, en \u003cem\u003eIntroducci\u0026oacute;n a la investigaci\u0026oacute;n cualitativa: fases, m\u0026eacute;todos y t\u0026eacute;cnicas.\u003c/em\u003e, Madrid: Ediciones S\u0026iacute;ntesis, 2016, pp. 43-44.\u003c/li\u003e\n\u003cli\u003eR. Ratnayake, M. Tammaro, A. Tiffany, A. Kongelf, J. A. Polonsky, y A. McClelland, \u0026laquo;People-centred surveillance: a narrative review of community-based surveillance among crisis-affected populations\u0026raquo;, \u003cem\u003eLancet Planet. Health\u003c/em\u003e, vol. 4, n.\u003csup\u003eo\u003c/sup\u003e 10, pp. e483-e495, oct. 2020, doi: 10.1016/S2542-5196(20)30221-7.\u003c/li\u003e\n\u003cli\u003eC. R. McGowan \u003cem\u003eet al.\u003c/em\u003e, \u0026laquo;Community-based surveillance of infectious diseases: a systematic review of drivers of success\u0026raquo;, \u003cem\u003eBMJ Glob. Health\u003c/em\u003e, vol. 7, n.\u003csup\u003eo\u003c/sup\u003e 8, ago. 2022, doi: 10.1136/bmjgh-2022-009934.\u003c/li\u003e\n\u003cli\u003eB. A. Israel, A. J. Schulz, E. A. Parker, y A. B. Becker, \u0026laquo;Review of community-based research: assessing partnership approaches to improve public health\u0026raquo;, \u003cem\u003eAnnu. Rev. Public Health\u003c/em\u003e, vol. 19, pp. 173-202, 1998, doi: 10.1146/annurev.publhealth.19.1.173.\u003c/li\u003e\n\u003cli\u003eK. Rustage \u003cem\u003eet al.\u003c/em\u003e, \u0026laquo;Participatory approaches in the development of health interventions for migrants: a systematic review\u0026raquo;, \u003cem\u003eBMJ Open\u003c/em\u003e, vol. 11, n.\u003csup\u003eo\u003c/sup\u003e 10, p. e053678, oct. 2021, doi: 10.1136/bmjopen-2021-053678.\u003c/li\u003e\n\u003cli\u003eWHO/AFRO, \u003cem\u003eIntegrated Diseases Surveillance and Response in the African Region: Community-based Surveillance (CBS) Training Manual\u003c/em\u003e. 2015. Accedido: 19 de enero de 2025. [En l\u0026iacute;nea]. Disponible en: https://www.afro.who.int/publications/integrated-diseases-surveillance-and-response-african-region-community-based\u003c/li\u003e\n\u003cli\u003eD. H. Peters, T. Adam, O. Alonge, I. A. Agyepong, y N. Tran, \u0026laquo;Republished research: Implementation research: what it is and how to do it\u0026raquo;, abr. 2014, doi: 10.1136/bmj.f6753.\u003c/li\u003e\n\u003cli\u003eJ. Smith, O. van der Groen, y Y. Learmonth, \u0026laquo;Feasibility Meets Implementation Science: Narrowing the Research-To-Practice Gap for Exercise Activity in Multiple Sclerosis\u0026raquo;, \u003cem\u003eInt. J. Qual. \u003c/em\u003e\u003cem\u003eMethods\u003c/em\u003e, vol. 22, p. 16094069231180162, ene. 2023, doi: 10.1177/16094069231180162.\u003c/li\u003e\n\u003cli\u003eI. Irarr\u0026aacute;zaval, P. Streeter, y I. Salas, \u003cem\u003eComprometidos con Chile:La contribuci\u0026oacute;n de las organizaciones de la sociedad civil a la infancia y las personas mayores\u003c/em\u003e. Santiago de Chile, 2018. [En l\u0026iacute;nea]. Disponible en: https://politicaspublicas.uc.cl/web/content/uploads/2019/01/Libro_ContibucionOSC_SociedadenAccion_Final-3.pdf\u003c/li\u003e\n\u003cli\u003eC. Mergenthaler \u003cem\u003eet al.\u003c/em\u003e, \u0026laquo;Feasibility and challenges in sustaining a community based surveillance system in post-Ebola Sierra Leone\u0026raquo;, \u003cem\u003eConfl. Health\u003c/em\u003e, vol. 18, p. 69, nov. 2024, doi: 10.1186/s13031-024-00618-0.\u003c/li\u003e\n\u003cli\u003eD. Malmusi, C. Borrell, y J. Benach, \u0026laquo;Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin\u0026raquo;, \u003cem\u003eSoc. Sci. Med. 1982\u003c/em\u003e, vol. 71, n.\u003csup\u003eo\u003c/sup\u003e 9, pp. 1610-1619, nov. 2010, doi: 10.1016/j.socscimed.2010.07.043.\u003c/li\u003e\n\u003cli\u003eA. Woodward, N. Howard, y I. Wolffers, \u0026laquo;Health and access to care for undocumented migrants living in the European Union: a scoping review\u0026raquo;, \u003cem\u003eHealth Policy Plan.\u003c/em\u003e, vol. 29, n.\u003csup\u003eo\u003c/sup\u003e 7, p. 818, oct. 2014, doi: 10.1093/HEAPOL/CZT061.\u003c/li\u003e\n\u003cli\u003eK. Crenshaw, \u0026laquo;Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color\u0026raquo;, \u003cem\u003eStanford Law Rev.\u003c/em\u003e, vol. 43, n.\u003csup\u003eo\u003c/sup\u003e 6, pp. 1241-1299, 1991, doi: 10.2307/1229039.\u003c/li\u003e\n\u003cli\u003eM. Dom\u0026iacute;nguez Amor\u0026oacute;s y P. Contreras Hern\u0026aacute;ndez, \u0026laquo;Agencia femenina en los procesos migratorios internacionales: una aproximaci\u0026oacute;n epistemol\u0026oacute;gica\u0026raquo;, \u003cem\u003eEmpiria Rev. Metodol. Cienc. Soc.\u003c/em\u003e, n.\u003csup\u003eo\u003c/sup\u003e 37, pp. 75-99, 2017.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Feasibility, Community-based Surveillance, Migrants, Sexual Health, Implementation Research","lastPublishedDoi":"10.21203/rs.3.rs-9440464/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9440464/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCommunity-based surveillance in sexual health represents a promising strategy to address the inequalities faced by migrant populations. This study aimed to assess the feasibility of a community-based surveillance system for migrant populations in Chile, considering its acceptability, integration, demand, implementation, and potential for expansion.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative study was conducted based on Bowen\u0026rsquo;s framework to evaluate the feasibility of the monitoring system during and after its implementation. Follow-up records, interviews, and focus groups with members of community organizations and migrant participants\u0026mdash;selected through convenience sampling\u0026mdash;were analyzed. A deductive content analysis was performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe monitoring system was highly accepted by both community-based organizations and migrant participants, who emphasized its relevance, capacity to foster reflection, and focus on self-care. Facilitators included the organizations\u0026rsquo; capacity to adapt and the technical support provided by the COSMIC team. Identified barriers included limited human and financial resources, weak articulation with primary health care, and operational challenges that required adjustments and reinforcement of community-based strategies.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe monitoring system proved to be feasible and demonstrated strong potential for scale-up, provided that minimum conditions for sustainability are secured, such as institutional strengthening, stable funding, effective integration with the health system, and reliable detection of vulnerable situations.\u003c/p\u003e","manuscriptTitle":"Feasibility of a community-based monitoring system for sexual health in migrants: A comprehensive real-time and post implementation evaluation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 10:51:20","doi":"10.21203/rs.3.rs-9440464/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-11T13:06:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299231268676233514836209044968555612490","date":"2026-05-06T09:50:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287285871679815487068198030735062685382","date":"2026-05-05T18:27:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T14:26:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265242871396311717390075147124152999802","date":"2026-05-04T16:51:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222478130995067458993745886544523104190","date":"2026-05-03T16:36:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180230303305471547816141496075031419354","date":"2026-05-01T13:11:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-01T05:53:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-23T13:35:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-23T13:34:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Public Health","date":"2026-04-16T15:51:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"db7e30cd-84cc-4be4-a152-ced38aea041e","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-11T13:06:23+00:00","index":31,"fulltext":""},{"type":"reviewerAgreed","content":"299231268676233514836209044968555612490","date":"2026-05-06T09:50:16+00:00","index":29,"fulltext":""},{"type":"reviewerAgreed","content":"287285871679815487068198030735062685382","date":"2026-05-05T18:27:56+00:00","index":28,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T14:26:18+00:00","index":27,"fulltext":""},{"type":"reviewerAgreed","content":"265242871396311717390075147124152999802","date":"2026-05-04T16:51:39+00:00","index":26,"fulltext":""},{"type":"reviewerAgreed","content":"222478130995067458993745886544523104190","date":"2026-05-03T16:36:09+00:00","index":24,"fulltext":""},{"type":"reviewerAgreed","content":"180230303305471547816141496075031419354","date":"2026-05-01T13:11:02+00:00","index":23,"fulltext":""},{"type":"reviewersInvited","content":"13","date":"2026-05-01T05:53:47+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T10:51:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 10:51:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9440464","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9440464","identity":"rs-9440464","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}