Barriers and facilitators for the implementation of HP actions at the municipal level: a Swiss study

Abstract Background Municipalities are key players in the field of health promotion (HP). However, as in many other countries, municipalities have no specific HP mandate, which in Switzerland is a federal and canton responsibility. Only a few municipalities explicitly engage in HP, and rarely make use of the support and guidance services offered to them by other HP actors. The BeComES study conducted in the Canton of Vaud (Switzerland) explores a) the actions implemented at the municipal level, and b) the expectations of municipal actors regarding HP. Based on our results, we propose recommendations on how to reinforce municipalities’ engagement in HP. Methods The study uses a mixed-methods design: (1) literature review focusing on barriers and enablers for integrating HP at the local level; (2) 20 semi-structured interviews with cantonal and municipal decision-makers, HP and social sector professionals working in municipalities; (3) quantitative survey of 243 municipal actors; (4) recommendations will be discussed and drawn up on participatory workshops with various stakeholders. Results 47% of survey's respondents believe municipalities play a key role in HP, while only 10% feels their municipality gives it no importance. The number and type of HP actions vary significantly between municipalities. Only 13% have an HP policy or a dedicated HP person (13%). Municipal actors listed a lack of financial and human resources, unclear distribution of roles among the different political levels, and limited knowledge and use of available support services as major barriers to implementing HP actions. Conclusions These initial results indicate disparities in how municipalities perceive HP, define their role, and mobilize resources. This study will enhance our understanding of these local dynamics and nurture the co- development of recommendations to strengthen HP at the municipal level. Key messages • Municipalities are key HP actors but face barriers. We identify these challenges and offers directions on how governments and health professionals can better support municipal actors engaging in HP. • Understanding local realities is essential to strengthen health promotion (HP) at the municipal level. Our findings guide the development of more effective, targeted suggestions for municipal actors.