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Updated: Jun 26, 2025

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Tracking the Development of Community Engagement Over Time: Realist Qualitative Study.

Esther de Weger1,2, Hanneke Drewes3, Katrien Luijkx1

  • 1Department of Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands.

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Summary

Community engagement (CE) in healthcare has shifted towards more community-focused, practical initiatives. Successful CE requires investment in the engagement environment and a shared vision for better integration into organizational cultures.

Keywords:
citizen involvementcommunity engagementdecentralizationhealth carerealist evaluation

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Area of Science:

  • Public Health
  • Health Services Research
  • Community Engagement Studies

Background:

  • Growing interest in community engagement (CE) in healthcare development has not translated into clear strategies for success.
  • Evidence-based enablers and barriers for CE are known, but practical application remains a challenge.

Purpose of the Study:

  • To investigate changes in community engagement (CE) approaches over four years in six Dutch regions.
  • To understand citizens' and professionals' experiences driving these changes in CE.

Main Methods:

  • A realist qualitative case study analyzed four years of data (documents, interviews, observations).
  • New interviews were conducted to explore experiences, with results validated by a panel.

Main Results:

  • CE approaches evolved towards community-focused, relationship-building, and practical health promotion activities.
  • Key challenges included a lack of engagement environment, leadership, and shared vision.
  • Misalignment in perspectives between citizens and professionals, and insufficient long-term support for initiatives were identified.

Conclusions:

  • Community engagement (CE) is not yet fully embedded in organizational cultures, leading to smaller-scale approaches.
  • Investment in the engagement environment and a shared vision are crucial for advancing CE.
  • Overcoming these barriers can help CE move beyond smaller-scale implementations.