JMIR Publications

ABSTRACT

Background:

Organisations have increasingly been trying to engage citizens in the development of health(care) services, neighbourhoods and healthy living environments. However, this growing interest in engaging communities has not automatically led to progress or consensus as to how to engage communities successfully, despite the evidence-base showing how to leverage enablers and how to alleviate barriers

Objective:

To bridge the gap between the evidence-base and which community engagement (CE) approaches have actually been applied in practice over time, this paper investigates how CE approaches have changed over the past four years in six different regions in the Netherlands and citizens’ and professionals’ experiences implementing CE approaches.

Methods:

For the last stage of a multiple case-study following the development of CE approaches in six different regions in the Netherlands, a realist qualitative case-study was conducted. To investigate how CE approaches had changed over the past four years, data from the entire four years of the study were used, including (strategy) documents, interview transcripts, and observation templates (T0-4). To examine citizens’ and professionals’ experiences underlying these changes, new interviews were held with citizens and professionals involved in the CE approaches (T4). Subsequently, these latest interview results (n=10; T4) were discussed with a panel consisting of citizens, professionals, and experts to enrich the results and to ensure the results had face validity (n=17).

Results:

The regions had implemented different types of CE approaches over the past four years and were adapting these approaches over time. Many of the (remaining) approaches may be operating on a smaller-scale. The study identified overarching themes along which CE had been adapted: • Fewer region-wide approaches, more community-focussed approaches; • More focus on building relationships with (already-engaged) citizens and community-led initiatives; • More focus on practical and tangible health promotion and social cohesion activities, less on complex ‘abstract’ programmes. All participants had experienced the engagement environment as insufficient. To support CE, professionals experienced the need to develop and receive more facilitative leadership and to develop approaches better equipped to involve citizens in the decision-making process. Citizens experienced the need to better align citizens’ and professionals’ motivations and aims for CE approaches and to receive longer-term financial support for their community-led initiatives.

Conclusions:

This study suggests that CE has not yet been embedded within organisational cultures. This has arguably meant that the (remaining) CE approaches are operating on a smaller-scale. To enable the further development of CE approaches an investment in the engagement environment is required (e.g. through more structural organisational support, time and space to innovate and improve CE, more facilitative leadership (from and for organisations), and a shared vision underpinned with alignment between citizens’ and professionals’ motivations. Only then could CE within the regions move beyond the more seemingly smaller-scale CE approaches.