In order to reduce health inequities, a socio-ecological approach and community engagement are needed to develop sustained interventions with a positive effect on the health of disadvantaged groups. This qualitative study was part of the development phase of a community health promotion programme. The study aimed to provide insight into the perceptions of parents in a disadvantaged neighbourhood about health, and their priorities for the community health programme. It also described the process of integrating these perceptions in the development of a multilevel plan for this programme. Participatory methods were applied to enable the engagement of all groups involved. Ten parents from a low-income neighbourhood in the Netherlands participated in five panel sessions. Parents’ priorities for improving family health were reducing chronic stress and not so much healthy eating and physical activity. They prioritised solutions to reduce their financial stress, to provide a safe place for their children to meet and play and to establish good quality communication with authorities. The programme development process resulted in objectives in which both parents and professionals were willing to invest, such as a safe playground for children. This study shows that target population engagement in health programme development is possible and valuable.

Background Since 1986, WHO has advised that applying action principles such as citizen participation and intersectoral collaboration leads to better health. However, less is known about the workability of these principles and how they trigger specific outcomes in interaction with the context. A critical realist perspective was applied to get a better understanding of what worked, and why it worked, in the context of a Dutch community-based health promotion programme (CBHPP). The aim of the study was to unravel the mechanisms underlying the action principles and find combinations of contextual factors and mechanisms that trigger outcomes in a CBHPP. Methods In this single case study, a critical realist methodology was followed. Qualitative data used in this study originated from multiple sources and methods to ensure validity. They include evaluation sessions with coalition members (n = 6) and individual interviews (n = 6); group sessions with community workers (n = 1), a health broker (n = 1), and citizens (n = 12); and seven semi-annual progress reports and minutes of the coalition meetings. The collected data were then compared with the programme theory through a heuristic process of constructing, exploring, and refining context-mechanism-outcome configurations. Results The programme initiated a variety of new activities that differed in content, intensity, duration, and number of participants, organised and implemented together with citizens. The most prominent mechanism underlying both action principles were programme-related, namely, patience, personal contact, contribution of budget, and the programme coordinator’s leadership. Another important mechanism was creating visibility, which resulted in the involvement of the municipality and a budget to sustain the programme. Conclusion In this case study, personal contact, patience, perseverance, participatory action research activities, and visibility were found to be the most notable mechanisms underlying the citizen participation and intersectoral collaboration action principles. As the principle-based approach added value to the existing context and introduced most of the mechanisms that triggered the outcomes, it is recommended to include citizen participation and intersectoral collaboration not only as action principles but explicitly as targets in a CBHPP.

Background Health inequalities persist, and policymakers, researchers and practitioners seek for effective ways to positively impact the health of disadvantaged people. Researchers point to a multi-component program with an integral design including various perspectives and involving different stakeholders. Few studies address the perspectives on health of disadvantaged people themselves. This study describes what parents in a socially disadvantaged situation and professionals working in that community perceived as 1) priority aspects to improve family health 2) barriers and facilitators for health behaviour changes 3) important health program activities. Methods Design: Community-based participatory action research. 10 parents participated in 6 panel meetings. 46 professionals received 4 panel meetings summaries. 18 parents and 25 professionals responded to questions in (panel) meetings and consultation by phone and e-mail. Results (preliminary) 1) Parents’ top priorities for improving health were: less stress related to finances and communication with related organizations, followed by a safe place for kids to meet. Of the program financers’ aims (reducing tobacco, alcohol use and overweight) reducing overweight got relatively most support of parents. 2) Parents perceived their family financial situation as barrier to behaviours reducing stress and overweight. 3) Program activities related to reducing stress got more support from parents and professionals than activities related to reducing overweight. Conclusions Insight in the perspectives of disadvantaged parents and professionals resulted in a program plan supported by them, aiming to reduce stress and overweight. Most participating parents and professionals committed themselves to invest time in program activities execution. Key messages Disadvantaged parents perceived reducing stress related to finances as top priority to improve family health. They perceived family finances as barrier to behaviours reducing stress and overweight. Community-based participatory action research with disadvantaged parents and professionals can result in an integrated family health program plan with stakeholder support.

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