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A participatory systems approach in community health promotion: Lessons learnt from an overall evaluation of a program to reduce health inequities

Author

Listed:
  • Wagemakers, Annemarie
  • Elkhuizen, Samantha
  • Bindels, Anner
  • Wachter, Marte
  • Niewold, Dagmar
  • Derkzen, Marthe
  • Thompson, Kristina

Abstract

To address the complexity and multi-level dynamics in health promotion, participatory and systems approaches have recently gained attention. We combined these into a participatory systems approach, which actively involves stakeholders in the planning, implementation, and evaluation of health promotion initiatives. This approach promotes cross-sector collaboration, shared understanding, joint decision-making, empowerment, and acknowledges the dynamic, interconnected factors that influence health over time. However, practical guidance on how to implement and evaluate such complex programs remains limited, particularly on aligning implementation and evaluation. We applied a participatory systems approach to the planning and implementation of an overall evaluation of a program aimed at enhancing the health of families in vulnerable positions in the Netherlands, with the goal of sharing lessons learnt from this process. From the program, four projects in four municipalities were selected for this study. We studied the processes and results of the overall evaluation in four iterative steps: conducting participatory action research with the four projects, semi-structured interviews with the four case managers, three consortium reflection and learning sessions and document analysis. We identified five themes: flexibility; research and practice needs; research capacity; roles of stakeholders and defining boundaries. The main lessons from our participatory systems approach are: flexibility is needed to realise stakeholder participation; balance research with practice; ensure adequate research capacity; define the roles of stakeholders and explore system boundaries continuously. The implementation of these lessons is supported by a reflection and learning culture. These lessons are relevant for practitioners, researchers, policymakers and citizens in effectively planning, implementing and evaluating health promotion programs.

Suggested Citation

  • Wagemakers, Annemarie & Elkhuizen, Samantha & Bindels, Anner & Wachter, Marte & Niewold, Dagmar & Derkzen, Marthe & Thompson, Kristina, 2025. "A participatory systems approach in community health promotion: Lessons learnt from an overall evaluation of a program to reduce health inequities," Evaluation and Program Planning, Elsevier, vol. 113(C).
    • Handle: RePEc:eee:epplan:v:113:y:2025:i:c:s0149718925001624
    DOI: 10.1016/j.evalprogplan.2025.102695
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    References listed on IDEAS

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    1. Liina Mansukoski & Bridget Lockyer & Amy Creaser & Jessica Sheringham & Laura Sheard & Philip Garnett & Tiffany Yang & Richard Cookson & Alexandra Albert & Shahid Islam & Robert Shore & Aiysha Khan & , 2023. "Meta-evaluation of a whole systems programme, ActEarly: A study protocol," PLOS ONE, Public Library of Science, vol. 18(6), pages 1-19, June.
    2. Wagemakers, Annemarie & Vaandrager, Lenneke & Koelen, Maria A. & Saan, Hans & Leeuwis, Cees, 2010. "Community health promotion: A framework to facilitate and evaluate supportive social environments for health," Evaluation and Program Planning, Elsevier, vol. 33(4), pages 428-435, November.
    3. McGill, Elizabeth & Er, Vanessa & Penney, Tarra & Egan, Matt & White, Martin & Meier, Petra & Whitehead, Margaret & Lock, Karen & Anderson de Cuevas, Rachel & Smith, Richard & Savona, Natalie & Rutter, 2021. "Evaluation of public health interventions from a complex systems perspective: A research methods review," Social Science & Medicine, Elsevier, vol. 272(C).
    4. Therese Riley & Liza Hopkins & Maria Gomez & Seanna Davidson & Jessica Jacob, 2024. "Correction: System Action Learning: Reorientating Practice for System Change in Preventive Health," Systemic Practice and Action Research, Springer, vol. 37(1), pages 17-18, February.
    5. Braveman, P.A. & Kumanyika, S. & Fielding, J. & LaVeist, T. & Borrell, L.N. & Manderscheid, R. & Troutman, A., 2011. "Health disparities and health equity: The issue is justice," American Journal of Public Health, American Public Health Association, vol. 101(SUPPL. 1), pages 149-155.
    6. Therese Riley & Liza Hopkins & Maria Gomez & Seanna Davidson & Jessica Jacob, 2024. "System Action Learning: Reorientating Practice for System Change in Preventive Health," Systemic Practice and Action Research, Springer, vol. 37(1), pages 1-16, February.
    7. Schwarzman, Joanna & Bauman, Adrian & Gabbe, Belinda J. & Rissel, Chris & Shilton, Trevor & Smith, Ben J., 2022. "How practitioner, organisational and system-level factors act to influence health promotion evaluation capacity: Validation of a conceptual framework," Evaluation and Program Planning, Elsevier, vol. 91(C).
    8. Jolley, Gwyneth, 2014. "Evaluating complex community-based health promotion: Addressing the challenges," Evaluation and Program Planning, Elsevier, vol. 45(C), pages 71-81.
    9. Lisa Wilderink & Ingrid Bakker & Albertine J. Schuit & Jacob C. Seidell & Ioana A. Pop & Carry M. Renders, 2022. "A Theoretical Perspective on Why Socioeconomic Health Inequalities Are Persistent: Building the Case for an Effective Approach," IJERPH, MDPI, vol. 19(14), pages 1-17, July.
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