Working towards a healthy living environment: mechanisms for effective community participation

Abstract Background A healthy living environment invites healthy behaviors, and protects against health risks. Working towards a healthy living environment requires community participation to ensure local needs are integrated, leading to more effective and supported outcomes. This is especially the case in vulnerable neighborhoods, where living environments tend to be less healthy. While existing studies often emphasize outcomes of community participation, they rarely unpack the mechanisms and contextual conditions that can realize this. This study explores what works and under what conditions in community participation in vulnerable neighborhoods in the Netherlands. Methods We used participatory action research and realist evaluation in a multiple case study conducted in three neighborhoods over a year. Data collection included document analysis, 23 interviews (n = 29), 3 Ripple Effects Mapping sessions, and 50+ meeting observations. Analysis focused on developing context-intervention-mechanism-outcome configurations. Results Successful community participation requires open, frequent, and tailored communication. Citizens appreciate being kept informed, even when updates seem minor or irrelevant, as this fosters trust and a sense of equality. In vulnerable neighborhoods, personal relationships with municipal professionals was especially valued. Moreover, community members emphasized the importance of having space for open input during participation processes. Residents felt a stronger sense of ownership, resulting in initiatives to improve livability, such as increased green spaces. Conclusions In vulnerable neighborhoods, personal and sustained contact was crucial to build trust and foster meaningful participation. Community participation led to visible improvements in the living environment, which are more likely to be maintained and supported because they are rooted in local ownership and a deep understanding of community needs. Key messages • Successful community participation relies on trust, personal contact, and open communication. • Flexibility and shared ownership enable residents to initiate change in their living environment.