Searching for new community engagement approaches in the Netherlands: a realist qualitative study

E De Weger,C A Baan,K G Luijkx,N J E Van Vooren,H W Drewes

doi:10.1186/s12889-020-08616-6

E De Weger, C A Baan + Show 3 more

Open Access

https://doi.org/10.1186/s12889-020-08616-6

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Abstract

BackgroundCommunity engagement is increasingly seen as key to improving healthcare systems and to increasing communities’ involvement in the shaping of their own communities. This paper describes how ‘community engagement’ (CE) is understood and being operationalised in the Dutch healthcare system by investigating the CE approaches being implemented in six different regions and by examining engaged citizens’ and professionals’ experiences of those CE approaches.MethodsFor this realist study, interviews and focus groups were held with citizens (16) and professionals (42) involved in CE approaches in the six regions. Additionally, CE-related activities were observed to supplement interview data.ResultsThis study shows that citizens and professionals defined and experienced CE differently and that they differed in who they felt had ownership of CE. The CE approaches implemented in community-led initiatives and organisationally-led initiatives varied accordingly. Furthermore, both citizens and professionals were searching for meaningful ways for citizens to have more control over healthcare in their own communities.ConclusionCE can be improved by, first of all, developing a shared and overarching vision of what CE should look like, establishing clear roles and remits for organisations and communities, and taking active measures to ensure CE is more inclusive and representative of harder-to-reach groups. At the same time, to help ensure such shared visions do not further entrench power imbalances between citizens and professionals, professionals require training in successful CE approaches.

Highlights

Community engagement is increasingly seen as key to improving healthcare systems and to increasing communities’ involvement in the shaping of their own communities
This transition coincided with the decentralisation of health and care policies and services [9, 38, 46] and with a sharp increase in community-led initiatives which are broadly centred on issues regarding health, care and healthy neighbourhoods [29]
Building on from the rapid realist review (RRR) by using the guiding principles as initial programme theories, and as the basis for the analytical framework, this paper describes the second stage of the study, which explored the underlying contextual factors and mechanisms explaining how community engagement’ (CE) is being developed and experienced in six different regions in the Netherlands

Summary

Introduction

Community engagement is increasingly seen as key to improving healthcare systems and to increasing communities’ involvement in the shaping of their own communities. Community engagement (CE) is seen as key to the development of citizen-centred and sustainable healthcare systems and to the improvement of citizens’ health and wellbeing [5, 30]. With the concept of a ‘participation society’ [37] the Dutch government emphasised the transition from a ‘classic welfare state’ to a ‘participation society’ requiring all able citizens to take responsibility for their own lives and environments [44] This transition coincided with the decentralisation of health and care policies and services [9, 38, 46] and with a sharp increase in community-led initiatives which are broadly centred on issues regarding health, care and healthy neighbourhoods [29]

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