Unraveling community engagement in health promotion among vulnerable families: a multiple case study

Abstract

Abstract Community engagement has since long been promoted among health promotion practitioners, policy-makers and scientists. However, many uncertainties remain when it comes to the workings and effects of community engagement in health promotion. The aim of this study is to provide in-depth insights into the workings and effects of community engagement. In a multiple case study, we investigate three health promotion projects among vulnerable families in The Netherlands. The projects are all funded by the Healthy Futures Nearby Programme. Data was collected by group interviews, telephone interviews and written progress reports. We adopted a realist approach, in which we first identified assumptions about community engagement. We then analysed the qualitative data for context-mechanism-outcome configurations to test and refine this programme theory. Preliminary results show that active engagement can strengthen social networks, empowerment and perceived health among vulnerable families. However, specific contexts, in combination with the project interventions, may or may not trigger positive responses (mechanisms). Vulnerable families may feel they matter when asked to actively contribute in a project, which in turn can enhance their self-confidence. In another context, we found vulnerable families overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. We will present a full list of context-mechanism-outcome configurations that describe possible effects of community engagement of vulnerable families. The two sides of the assumptions project teams hold about effects of community engagement, show that tension exists around actively involve communities in health promotion projects. In-depth insights into the workings and effects of community engagement will provide health promotion scientists and practitioners with knowledge to shape and optimize community engagement in health promotion projects. Key messages The study shows that, in practice, tensions exist between expected effects of community engagement and actual unclarity about what community engagement can do in for vulnerable people. Contexts of health promotion projects, in combination with specific interventions, may or may not trigger positive responses to active involvement among vulnerable families.