Abstract
Objectives
Evidence shows that community health promotion projects should be participatory. However, contextual factors affect the ways these projects can be designed and implemented. This article is part of a study to implement evidence-based guidelines to promote community engagement and it describes barriers and facilitators that can influence its implementation.
Study design
Qualitative explorative study using semi-structured interviews and interactive workshops in 13 community health promotion projects across Spain.
Methods
Data were collected through semi-structured interviews and workshops with 68 participants from core working groups and key stakeholders from 13 community health projects. Descriptive thematic analysis helped identify codes related to barriers and facilitators. Data were then organized in a matrix to identify how each factor influenced each project (content analysis) and to what degree (totally, partially or absent).
Results
Fourteen facilitators were identified, related to internal organization and strategies to work effectively; and seven barriers, related to lack of resources, dependence on external factors and not knowing how to evaluate.
Conclusions
Most of the factors identified are related to the organisation of the project, with no apparent relation with community engagement. This suggests that organisational structures should be prioritise to ensure the quality of community health promotion projects and their continuity, and to enable engagement of community members throughout a project.
Keywords: Community participation, Community health planning, Health promotion, Public health interventions
1. Introduction
Health promotion (HP) centres on actions aimed at modifying the socio-economic and environmental conditions in which people live, to promote positive impact on their health [1]. To develop HP approaches, it is key to start from people's needs, recognise and promote their strengths, account for the contexts where they live, and work with different sectors and at different levels. Thus, working in HP implies a different form of collaboration where participation is key [[1], [2], [3], [4]]. In fact, one of the lines of action of HP, ‘strengthen community action', defined as the dynamization of social relations and cooperation between people in a local area [4], encourages the participation of the community to establish health needs and priorities, make decisions to improve their health, and design and implement strategies and evaluate them. However, community actions can be implemented in different contexts, and this dynamization of relationships adapts accordingly. To promote community engagement (CE) in health, NICE developed evidence-based guidelines [5] which were then adapted to the Spanish context through a collaborative research project [6]. This article is part of a larger research, EvaluA GPS, whose objective was to develop a tool to implement these adapted guidelines. In this project, the term community refers to people and organisations, and their dynamic relationships, co-existing in a defined place [4]. Hence the importance of understanding the contexts and key stakeholders involved in community HP projects, to take into account potential challenges in the planning and implementation of community actions with a participatory approach. This article aims to identify the barriers and facilitators that can influence the implementation of CE approaches in local HP projects.
2. Methods
Qualitative study in 13 community HP projects in 5 Spanish regions: Andalusia, Galicia, Valencian Community, Balearic Islands and Aragon, selected following the criteria established in the study protocol [7]. Data were collected through semi-structured interviews (one interview per project, individual or in small groups, depending on the type of project) (guidelines available in Spanish elsewhere [7]) with a theoretical sample of representatives of each project (n = 28) to discuss its origin and its organisation. Additional qualitative data were collected through workshops with a total of 68 key stakeholders (see Table 1 for participants’ profiles). The aim of the workshops was to implement the Evalguía tool, a tool designed to implement evidence-based CE guidelines [8]. In 10 projects, the workshops were carried out by the EvaluA GPS researchers while the remaining 3 projects organised the implementation autonomously (details of the workshops contents available in the protocol [7]). The interviews and workshops were audio-recorded, with prior informed consent. The interviews’ transcription together with the audio-recorded workshops were imported in the NVivo software v12 for analysis. A descriptive thematic analysis was carried out on all these data to identify organisational and contextual factors that could act as facilitators and barriers to implement CE. To strengthen this analysis, these initial findings were presented to 11 EvaluA GPS team members, to discuss their impact and group them into themes. Data were then organised into a matrix to identify which factors influenced each project (following a content analysis approach [9]) and to what degree (totally, partially, absent or no data available).
Table 1.
Study participants.
| PROJECT | PARTICIPANT IN SEMI-STRUCTIRED INTERVIEWS | PARTICIPANTS WORKSHOP 1 |
|---|---|---|
| P1 - local community partnership | Social worker and psychologist | Council's social worker and psychologist, local organisation's social worker and women centre's psychologist, two local volunteers, local council representative, mental health worker |
| P2 - NGO | two front-line community volunteers coordinating the local project | three front-line community volunteers coordinating the local project |
| P3 - local organisation | director and social worker | director, social worker and front-line worker |
| P4 - local health action | Social worker and community educator | Primary health care doctor, social worker, a community educator, project admin and a local volunteer |
| P5 - local health action | primary health care doctor and nurse | primary health care doctor, nurse, three women as community members participating in the activities |
| P6 - local health action | primary health care doctor and nurse | primary health care doctor, three nurses, a physiotherapist, local council representative, four women as community members participating in the activities |
| P7 - NGO | three front-line community and education workers | three front-line community and education workers |
| P8 - local health action | Health centre medical coordinator | Health Department nursing coordinator, health centre medical coordinator, nurse assistant, two health centre nursing coordinator, public health centre's nurse, three primary health care centre's nurses |
| P9 - local community partnership | Project's social worker and primary health care doctor | Project's social worker and primary health care doctor, local council representative, two neighbours |
| P10 - local community partnership | Project's social worker and front-line community worker | Project's social worker and front-line community worker, representative of neaighbourhood association, two representatives of local schools, local council's social worker |
| P11 - local health action - autonomous | A paediatrician, a university professor, a representative of the council youth department | Two paediatricians, a university professor, a representative of the council youth department |
| P12 - local community partnership - autonomous | Local council representative and primary health care doctor (who is also a memebr of the local council) | Local council representative and primary health care doctor (who is also a memebr of the local council) |
| P13 - local health action - autonomous | three front-line community workers | three front-line community workers |
3. Results
The analysis identified 14 facilitators (Requirements (n = 6) and Tools and Strategies (n = 8)), and 7 barriers. Although all these factors can act positively when present and negatively when absent, the differentiation between being facilitators or barriers was pointed out by the interviewees themselves and it was therefore maintained. Table 2 presents a summary of the factors identified in each project. Annexes I and II provide a more detailed description of each facilitator and barrier, with examples of quotes from participants.
Table 2.
Facilitators and barriers to implement community engagement across the 13 projects.
3.1. Facilitators: requirements
The requirements were those factors that were discussed by participants as essential for the development of community-based projects per se, as some sort of necessary pre-conditions. Receiving full institutional support was reported as a main facilitator in 6 projects, while 3 only received partial support. The remaining four perceived the lack of support as a difficulty to plan and implement activities.
In terms of dedicated resources, seven projects had some financial and material resources specifically destined to it. However, in terms of human resources, although in nine of the projects, front-line staff dedicate part of their working hours to the project, all participants commented that they have to dedicate also part of their free time to it, with one project being entirely dependent on volunteer work.
" because those of us who are involved in these things, it always ends up being outside of our working hours." [Autonomous 2]
Three projects report having full technical support (for admin work, communication and methodological support), of which two receive it from an external organisation or from their national human resources department (these were community projects carried out by local branches, but part of national non-governmental organisations). Six projects only receive limited support, to help with some of the admin tasks or communication strategies. They reported difficulties when organising the logistics for community activities or applying for funding. As for the methodological support, most projects lacking it found it challenging to create engaging activities and to evaluate, as it will be further discussed in the barriers section.
Another facilitator relates to the importance of believing that the project can improve people's health. This was reported by most interviewees as key to generate additional motivation to keep working.
"You have to be very enthusiastic to keep going and going, despite all the obstacles, because people can take time to get back to you, and it's exhausting[…], there is no institutional response. So, you have to have a lot of motivation, that's the strength." [Workshop & Support 9]
Only two projects, as they have an intersectoral core working group, comment that this motivation is not reflected in all sectors, and that is why ‘belief in the project’ is considered to be a factor that they only have 'in part'.
" There are those who are in favour of it and it does make it much easier for you […]. [but] there are some who holds you back." [Autonomous Implementation 3]
3.2. Facilitators: tools and strategies
Another group of enabling factors were categorised as tools and strategies. Only four projects reported having community members as part of their core working groups (and one only partially, as those community members engaging in the project did not represent the diversity of the whole community). This reflects the overall challenges in relation to promote effective CE. In addition, working with an intersectoral group (N = 8) was perceived as helpful to reach out to the rest of the community.
On another hand, having had prior training in CE or how to foster CE was reported as a key facilitating factor, even though only three projects actually discussed it.
"The project started from a course we had in our health centre, in which they wanted to convince us, literally, that community work was good for primary care. And well, I attended that training, without much expectation to be honest, but then I was half convinced and thought that it was true that we could work from other points of view and that we could do other things." [Workshop & Support 4]
In addition, having official recognition has been a facilitating factor according to eight projects, as it helps to justify the need for certain activities or the possibility of acting on certain issues:
"You go out there to work on certain projects and programs, but you often need some form of support to back us up, because for instance we are social workers, so we are not directly working with primary healthcare services" [Workshop and support 1]
As for the development of the project, holding team meetings (n = 11) or the use of new technologies for internal communication (n = 8) appear as factors that can facilitate it, together with the ability to adapt to needs and context. Finally, having previous relationships with other stakeholders in the area was identified by six projects as a clear facilitating factor to start new activities or partnership, and only partially by four:
"I have always led the program, and I personally participated in other volunteer actions, so, many people know me, many people know the association, so when we propose a collaboration and contact different entities of [name of the local community], they all respond" [Workshop and support 2]
3.3. Barriers
Although most of these facilitators can also act as a barrier (if they are absent or only partially present), there are seven factors that were explicitly identified as barriers: not being able to reach certain groups, professionals volunteering their time, lack of continuity of core staff, dependence on external funding or on other institutions, carry out evaluations (or not knowing how to evaluate), and not sharing information with the rest of the team.
Of the aforementioned barriers, most of the projects (n = 9) identify the difficulty to reaching out to certain groups, for example to people in vulnerable situations, such as people of Roma ethnic background, migrants, or older men experiencing loneliness:
"There are many Roma women in an area, but we don't know how to reach out to them, nor to their spaces" [Workshop and support 7]
Another factor, such as professionals volunteering their time, is related to the lack of human resources allocated to community projects, which affects most of the projects in the study. This is linked, in part, to dependence on external funding, a factor identified as a barrier in several projects (n = 6 fully and n = 4 partially):
"We don't know what next year's budget is, because we rely on grants and so we don't know whether or not we can hire the staff." [Workshop & Support 2]
In addition, there are five projects that depend on other institutions, which has been pointed out as a barrier when it comes to having to take decision related to the project or to be able to influence external factors that affect the project.
"We have not been able to reach most of the young population, because of [one] issue, which I think it’s fundamental: that there is one of the two local schools that does not want to collaborate in anything" [Autonomous 2]
With regard to evaluation, it is noteworthy that there is no project that claims to carry out or know how to carry out a complete evaluation. Only three projects reported doing some forms of process evaluations but without actually evaluating results.
"We don't have the knowledge, the tools or the time to carry out an evaluation. We have some information about processes, because all the actors are always informed, but real evaluation, we don't know, and we don't have time, evaluation takes a lot of time, and we can't stop to evaluate." [Workshop & Support 10]
Finally, it should be noted that four projects stated that they did not share any information from the limited process evaluation or else, with the rest of their team. For the rest, we have no data on this factor.
4. Discussion
This article identified facilitators or barriers to the implementation of evidence-based recommendations to improve CE in HP projects. Fourteen facilitators related to internal organisation and to strategies to work effectively, while seven barriers related to lack of resources, dependence on external factors and difficulties to conduct thorough evaluations.
Although there is extensive literature on the key role which HP can have in community health [[10], [11], [12], [13]], and the importance of ensuring quality criteria, such as: have institutional support, receive training, and work in intersectoral partnership, including the community [2], the findings from this study suggests these criteria are not always accounted for when it comes to the planning and implementation of health promotion projects.
First, having support from one own's institution is key to enhance HP programmes [14,15] as it facilitates the implementation of HP activities by allocating appropriate resources to the task and thus enhancing staff motivation to engage in community work [16]. This study adds to the literature on this topic as it found a difference between projects that, although they act at the local level, belong to a wider network at the national level and smaller projects that are only present at the local level. The former have an infrastructure and technical support that is already provided (thus facilitating the required 'institutional support' and associated administrative tasks, communication strategies and methodological support), while the latter must allocate resources to finance these technical and management aspects, which is an added difficulty when working on a tight budget. Therefore, implementing community HP projects as part of national or regional programmes could be prioritised, as it may result in facilitating local implementation [17], even though more studies are needed in this area. In relation to this, an important barrier identified in this study refers to professionals volunteering their free time. Despite the fact that CE and the health-promoting approach are included in the National Health System's legislative frameworks and services, at the institutional level these have not been sufficiently developed or supported, thus relying on the personal initiative of professionals to carry out community HP. This hinders the possibility of achieving the expected health outcomes and the long-term sustainability of community processes, and it may risk the loss of motivation and overload of the professionals engaged. It would be interesting to better define the community tasks expected from each professional, as well as to provide job stability and an adequate structure for their development [17,18].
This also relates to the lack of evaluation identified in this study. Difficulties exist when evaluating HP projects, as stated in the literature [19], and it may be related with the complexity of this type of interventions, which require new models to be evaluated [20] and a broadening of the perspective when it comes to identifying what can be health 'outcomes' and their determinants [21]. However, not evaluating implies not generating evidence on how community projects work and their results, which in turn affects the possibilities of fostering the 'institutional support' that is required for the proper functioning of the project itself [15,22].
Another facilitating factor such as receiving training on CE and/or participatory approaches is known to be an essential tool for both the community and the front-line workers (being these health professionals or community workers) as it would allow them, on the one hand, to have evidence-based knowledge on how to work on HP projects with a participatory approach, and on the other, to gain the skills and attitudes needed for collaborative work [23]. However, this study confirms the findings of previous analyses [24] regarding the lack of training on this topic within the Spanish context.
In relation to the importance of CE, several studies and guidelines highlight the importance of working together with community members from the beginning of a project, that is, including the community in the design, planning, development, evaluation and feedback of the results, creating co-production structures, ultimately to support communities in gaining control over the whole project [4,5,25,26]. In addition, there is evidence that members who have an active role in a core working groups can act as a 'bridge' with the rest of the population and bring the project closer to local realities [15]. However, an important finding from this study relates to the limited presence of community members in the core working groups of the selected projects. This limits the possibilities for local residents to engage in decision-making processes related to their health. Changing this would require that both managerial and technical staff of an organisation are willing to step out of their comfort zone to change the ‘uneven’ relationships established and to delegate power to the community. Nonetheless, it is also important to identify when and where CE approaches can be beneficial as to avoid forms of ‘fake’ engagement or engagement of those whose voices are already being heard, with a risk of widening inequalities [27].
Finally, this study found that this willingness to change relationships are needed not only when working with people in the community but also when working in partnerships with other organisations. Evidence shows that intersectoral work and previous relationships between the parties, identified as facilitating factors in this study, are key when working on HP [28,29], and relationships between representatives of different sectors should be based on trust and respect [30]. However, this study showed that formal partnership work is not always possible, since traditionally each sector works independently, with its own organisation and funding [31,32]. To counter this, it might be helpful to implement some forms of co-financing [33], as this would help when it comes to sharing the 'scarce' resources that are usually dedicated to community HP projects, as identified in this study.
5. Limitations of this study
The main limitation of the study is the number of participating projects (n = 13) which may affect the generalisability of the findings. However, results shows that the specific activities of each participating project did not affect the identification of common factors across them all, thus suggesting that the results of this study could be applicable to other community HP projects carried out in Spain or in countries with similar socio-cultural context and organisations.
6. Conclusions
This study identified different factors that act as facilitators or barriers to the implementation of CE evidence-based recommendations in HP projects. It is interesting to note that most of the facilitators and barriers are related to the structure and functioning of the project in general, without having an apparent direct relationship with CE. The factors identified are common to all projects included in this study, independently from the topic of their community activities. Therefore, it can be argued that, to promote CE in HP projects, it would be necessary for the project itself to have the basic structures for its proper functioning, to guarantee the quality of the activities carried out and their continuity, to then be able to create spaces and approaches to allow community members to have a more active role in the planning. These findings can help us to identify possible elements that facilitate or hinder the sustainability of community processes and to be able to take them into account for the planning of future community actions with a CE approach.
What this study adds
●This study identified factors that positively and negatively influence the implementation of evidence-based recommendations to improve community engagement in health
●Most of the facilitators and barriers identified are related to the structure and organisation of the project in general rather than specific to community engagement
●The factors identified are common to the projects included in this study, independently from the topic of their community activities.
Implications for policy and practice
●The identified factors should be taken into account when planning and implementing community health promotion project to promote people's engagement
●Since the factors identified are related to project organisation, there is a need to create structures that favour the development and sustainability of projects underpinned by a community engagement approach.
Statement of ethical approval
This study was approved by the Aragón Ethical Committee (CEICA).
Funding
This work was supported by the Health Institute Carlos III (ISCIII) through the project grant number PI19/01079; PI19/01525; PI19/00773, and co-funded by the European Union, Feder Funds Another way to make Europe. The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. The trial will be audited once a year by the funding organisation.
Declaration of competing interests
VC received funding from all three institutions to support the research coordination and data analysis. The rest of the authors have no competing interests to declare.
Acknowledgements
To all participating projects and to the rest of the EvaluAGPS Research Group: Aldecoa Landesa Susana; Aliaga Train Pilar; Baraza Cano Pilar; Barona Vilar Carmen; Bueno Manuel; Couso Viana Sabela; Dominguez Marta; Enriquez Natalia; Gallego Dieguez Javier; Gallego Royo Alba; Gea Caballero Vicente; Hernández Goméz Mercedes Adelaida; Iriarte María Teresa; Lou Alcaine María Luz; Martínez Pecharromán María del Mar; Morin Victoria; Nuñez Jiménez Catalina; Paredes-Carbonell, Joan; Peyman- Fard Nima; Pla Consegra Margarita; Romaguera Lliso Amparo; Romero Rodríguez, Esperanza; Ruiz Azarola, Ainhoa; Sainz Ruiz Pablo. EvaluAGPS Research Group is a multidisciplinary research group coordinated by three institutions: IISA (Instituto de Investigación Sanitaria de Aragón); FISABIO (Fundación para el Fomento de la Investigación Sanitaria y Biomédica, Comunitat Valenciana) and IMIBIC-FIBICO (Maimonides Institute for Biomedical Research of Cordoba, Andalucía).
Footnotes
Study location: 13 projects, distributed across five regions in Spain.
Supplementary data to this article can be found online at https://doi.org/10.1016/j.puhip.2025.100595.
Appendix A. Supplementary data
The following are the Supplementary data to this article:
References
- 1.WHO - World Health Organization . World Health Organization; 1986. WHO | The Ottawa Charter for Health Promotion. [Google Scholar]
- 2.Criterios de Calidad en Promoción de la Salud. 2012. RAPPS - Red Aragonesa de Proyectos de Promoción de la Salud. [Google Scholar]
- 3.Pérez Alonso E., Cofiño R., García Blanco D., Hernán-García M. Ministerio de Sanidad; 2023. Orientaciones didácticas para la acción comunitaria. [Google Scholar]
- 4.Ministerio de Sanidad . 2021. Acción Comunitaria para ganar Salud; p. 98. Madrid. [Google Scholar]
- 5.NICE . 2016. Community Engagement: Improving Health and Wellbeing and Reducing Health Inequalities. [Google Scholar]
- 6.Cassetti V., López-Ruiz V., Paredes-Carbonell J.J., Grupo de trabajo AdaptA GPS PARTICIPACIÓN COMUNITARIA: Mejorando la salud y el bienestar y reduciendo desigualdades en salud Guía adaptada de la Guía NICE NG44: «Community engagement: improving health and wellbeing and reducing health inequalities». Guiasalus.es. 2018 [Google Scholar]
- 7.Cassetti V., López-ruiz M.V., Gallego-royo A., Egea-ronda A., Gea-caballero V., Aviño Juan Ulpiano D., et al. Asistir, consultar, involucrar: ¿es necesario redefinir el concepto de participación comunitaria? Gac. Sanit. 2023;37 doi: 10.1016/j.gaceta.2023.102344. [DOI] [PubMed] [Google Scholar]
- 8.EvaluA GPS EvaluA GPS [internet] 2024. www.evaluagps.com [cited 2024 Jan 17]. Available from:
- 9.Neuendorf K.A. In: Advanced Research Methods for Applied Psychology Design, Analysis and Reporting. Brough P., editor. Routledge; New York: 2019. Content analysis and thematic analysis; pp. 211–223. [Google Scholar]
- 10.Balcazar H.G., de Heer H., Rosenthal L., Aguirre M., Flores L., Puentes F.A., et al. A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population, 2005-2008. Prev. Chronic Dis. 2010;7(2):A28. [PMC free article] [PubMed] [Google Scholar]
- 11.Taylor B., Mathers J., Parry J. A conceptual framework for understanding the mechanism of action of community health workers services: the centrality of social support. J. Public Health. 2019;41(1):138–148. doi: 10.1093/pubmed/fdx161. [DOI] [PubMed] [Google Scholar]
- 12.Bolton K.A., Kremer P., Gibbs L., Waters E., Swinburn B., de Silva A. The outcomes of health-promoting communities: being active eating well initiative—a community-based obesity prevention intervention in Victoria, Australia. Int. J. Obes. 2017:1–11. doi: 10.1038/ijo.2017.73. February. [DOI] [PubMed] [Google Scholar]
- 13.Bolton M., Moore I., Ferreira A., Day C., Bolton D. Community organizing and community health: piloting an innovative approach to community engagement applied to an early intervention project in south London. J. Public Health. 2016;38(1):115–121. doi: 10.1093/pubmed/fdv017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Rogers H.L., Pablo Hernando S., Núñez - Fernández S., Sanchez A., Martos C., Moreno M., et al. Barriers and facilitators in the implementation of an evidence-based health promotion intervention in a primary care setting: a qualitative study. J. Health Organisat. Manag. 2021;35(9):349–367. doi: 10.1108/JHOM-12-2020-0512. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Baxter S., Barnes A., Lee C., Mead R., Clowes M. Increasing public participation and influence in local decision-making to address social determinants of health: a systematic review examining initiatives and theories. Local Gov. Stud. 2022:1–30. [Google Scholar]
- 16.Rubio-Valera M., Pons-Vigués M., Martínez-Andrés M., Moreno-Peral P., Berenguera A., Fernández A. Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography. PLoS One. 2014;9(2) doi: 10.1371/journal.pone.0089554. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Diez E., Morrison J., Pons-Vigues M., Borrell C., Corman D., Burstrom B., et al. Una buena inversión: la promoción de la salud en las ciudades y en los barrios. [A good investment: promoting health in cities and neighbourhoods] Gac. Sanit. 2016 Aug;30(suppl.1):476–487. doi: 10.1016/j.gaceta.2016.04.015. [DOI] [PubMed] [Google Scholar]
- 18.Sastre Paz M., Benede Azagra C.B. In: PACAP. Orientación comunitaria: hacer y no hacer en Atención Primaria. Sastre Paz M., Benede Azagra C.B., editors. SemFYC; 2018. p. 37. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Wagemakers A., Vaandrager L., Koelen M.A., Saan H., Leeuwis C. Community health promotion: a framework to facilitate and evaluate supportive social environments for health. Eval. Progr. Plann. 2010;33(4):428–435. doi: 10.1016/j.evalprogplan.2009.12.008. [DOI] [PubMed] [Google Scholar]
- 20.Pawson R., Tilley N. Sage; 1997. Realistic Evaluation. [Google Scholar]
- 21.Keshavarz Mohammadi N. One step back toward the future of health promotion: complexity-informed health promotion. Health Promot. Int. 2019;34(4):635–639. doi: 10.1093/heapro/daz084. [DOI] [PubMed] [Google Scholar]
- 22.Stansfield J., South J., Mapplethorpe T. What are the elements of a whole centred system approach to community- public health ? A qualitative study with public health leaders in England ’ s local authority areas. BMJ Open. 2020:1–11. doi: 10.1136/bmjopen-2019-036044. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.López-Sánchez M.P., Alberich T., Aviñó D., Francés García F., Ruiz-Azarola A., Villasante T. Participatory tools and methods for community action. SESPAS Report 2018. Gac. Sanit. 2018;32(s1):32–40. doi: 10.1016/j.gaceta.2018.06.008. [DOI] [PubMed] [Google Scholar]
- 24.Juvinyà-Canal D., Espinal-Utgés S., Pertierra-Menéndez B., Rodríguez-Newey I., Gállego-Diéguez J. Gaceta Sanitaria; 2019 Jul. Descriptive Analysis of Training in Community Health Engagement in Spain. [DOI] [PubMed] [Google Scholar]
- 25.Barber R., Beresford P., Boote J., Cooper C., Faulkner A. Evaluating the impact of service user involvement on research: a prospective case study. Int. J. Consum. Stud. 2011;35(6):609–615. [Google Scholar]
- 26.Rycroft-Malone J., Burton C.R., Bucknall T., Graham I.D., Hutchinson A.M., Stacey D. Collaboration and co-production of knowledge in healthcare: opportunities and challenges. Int. J. Health Pol. Manag. 2016;5(4):221–223. doi: 10.15171/ijhpm.2016.08. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Popay J., Whitehead M., Ponsford R., Egan M., Mead R. Power, control, communities and health inequalities I: theories, concepts and analytical frameworks. Health Promot. Int. 2021;36(5):1253–1263. doi: 10.1093/heapro/daaa133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Kavanagh S.A., Hawe P., Shiell A., Mallman M., Garvey K. Soft infrastructure : the critical community - level resources reportedly needed for program success. BMC Public Health. 2022:1–10. doi: 10.1186/s12889-022-12788-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Hussain S., Javadi D., Andrey J., Ghaffar A., Labonté R. Health intersectoralism in the Sustainable Development Goal era : from theory to practice. Glob. Health. 2020;16(15):1–5. doi: 10.1186/s12992-020-0543-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Corbin J.H. Health promotion, partnership and intersectoral action. Health Promot. Int. 2017;32(6):923–929. doi: 10.1093/heapro/dax084. [DOI] [PubMed] [Google Scholar]
- 31.Rantala R., Bortz M., Armada F. Intersectoral action: local governments promoting health. Health Promot. Int. 2014 Jun 1;29:i92–i102. doi: 10.1093/heapro/dau047. [DOI] [PubMed] [Google Scholar]
- 32.Corbin J.H., Jones J., Barry M.M. What makes intersectoral partnerships for health promotion work? A review of the international literature. Health Promot. Int. 2018;33(1):4–26. doi: 10.1093/heapro/daw061. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Mcguire F., Vijayasingham L., Vassall A., Small R., Webb D., Guthrie T., et al. Financing intersectoral action for health : a systematic review of co-financing models. Glob. Health. 2019;15(86):1–18. doi: 10.1186/s12992-019-0513-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.