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

IF 2 4区社会学 Q2 SOCIAL SCIENCES, INTERDISCIPLINARY

Evaluation and Program Planning Pub Date : 2025-08-26 DOI:10.1016/j.evalprogplan.2025.102695

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

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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.

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社区卫生促进中的参与式系统方法：从减少卫生不公平规划的全面评价中吸取的经验教训

为了解决健康促进的复杂性和多层次动态，参与式和系统方法最近受到关注。我们将这些结合为一种参与式系统方法，使利益攸关方积极参与健康促进举措的规划、实施和评估。这种方法促进跨部门协作、共同理解、共同决策、增强权能，并承认长期影响健康的动态、相互关联的因素。然而，关于如何实施和评估这些复杂计划的实际指导仍然有限，特别是在协调实施和评估方面。我们采用参与式系统方法来规划和实施一项全面评估方案，该方案旨在加强荷兰弱势家庭的健康，目的是分享从这一进程中吸取的经验教训。从该方案中，选择了四个城市的四个项目进行研究。我们通过四个迭代步骤研究了整体评估的过程和结果：对四个项目进行参与性行动研究，对四位案例管理者进行半结构化访谈，三次联合反思和学习会议以及文件分析。我们确定了五个主题：灵活性；研究和实践需要；研究能力;涉众的角色和边界的定义。我们的参与式系统方法的主要教训是：实现利益攸关方参与需要灵活性；平衡研究与实践；确保足够的研究能力；定义涉众的角色，不断探索系统边界。这些课程的实施得到了反思和学习文化的支持。这些经验教训对从业人员、研究人员、政策制定者和公民有效规划、实施和评估健康促进方案具有重要意义。

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来源期刊

Evaluation and Program Planning SOCIAL SCIENCES, INTERDISCIPLINARY-

CiteScore

3.10

自引率

6.20%

发文量

112

期刊介绍： Evaluation and Program Planning is based on the principle that the techniques and methods of evaluation and planning transcend the boundaries of specific fields and that relevant contributions to these areas come from people representing many different positions, intellectual traditions, and interests. In order to further the development of evaluation and planning, we publish articles from the private and public sectors in a wide range of areas: organizational development and behavior, training, planning, human resource development, health and mental, social services, mental retardation, corrections, substance abuse, and education.