A Participatory Action Research study as a driver for change for prevention and health promotion: A co-creation process between professionals and citizens in two deprived neighborhoods in The Hague.

In the Hague, the Netherlands, health and social services, municipality and insurers started a new program Healthy and Happy the Hague to address health inequalities and poor health outcomes. The Ministry of Health, Welfare and Sport granted these involved parties funding for three years to improve health prevention and promotion. At the start of this programme participatory action research was used as an approach to gain insight in how prevention and health promotion can become successful in deprived neighborhoods and how self-rated positive health could be improved in two neighborhoods, Moerwijk and Laak.

Many evidence based interventions on prevention and health promotion do often not seem to reach citizens with a low socio-economic-status. A participatory action research was chosen to collect data on professionals and citizens perspectives and current issues around staying healthy and their views, dreams and solutions. Aim of the study was to facilitate the co-creation of initiatives by connecting citizens' experiences with evidence based solutions of professionals. Data were gathered through 120 semi-structured interviews, meetings in community-centres, schoolyards, sportsfields and other encounters in the neighborhoods. Findings and solutions were visualised and discussed in ten focus groups with citizens and professionals.

Based on thematic analysis of the interviews seven interconnected themes emerged around health: healthy money, healthy head, healthy relationships, growing up healthy, healthy food and exercise, healthy environment and healthy collaboration.During focus groups participants reflected upon the visualisations. A dialogue was started around several directions for solutions. Citizens stated they first needed to work on their relationships in the neighborhood and their mental health before they could work on other aspects of their health. Available resources, experiences and expertise were used for eighteen new initiatives. Professionals and citizens together discussed what the initiatives should look like and how everyone was going to contribute. Pitfalls already encountered during this process were the tendency of professionals to take over from citizens, the focus on what is wrong and not on what is strong, the lack of collaboration between professional organisations and the limited connections of professionals with the communities. Citizens confidence increased during the study as they contributed to initiatives on community groups and activities, groups for mental wellbeing, initiatives around sport activities and initiatives around cooking and healthy lifestyle. A group of professionals and citizens was trained together as action researchers. They especially want to address the living environment and growing up healthy as themes.

Mayor themes were discovered around prevention and health promotion. Citizens focus on solutions aimed at the collective of the community, as professionals mainly focus on the individual. Working together as professionals and citizens, community-up, is a promising approach to address health inequalities, building trust and creating ownership.

The early phase of the initiatives needs support for further development. During the process of co-creation managers need to give their professionals the space to work outside the box and question and alter current evidence based approaches in collaboration with citizens. Participatory action research, although time consuming at first, is easily transferable to other neighborhoods.