Network Strategies in Municipal Health Promotion: A Mixed-Methods Study

Municipal health promotion increasingly relies on intersectoral networks to address complex health challenges amid fragmented health, social and educational systems. However, little is known about how practitioners navigate these networks or how perceived strategies correspond with observed network structures. This convergent mixed-methods study involved 14 health professionals and combined qualitative interviews with egocentric network analysis. Interview data were analysed using deductive content analysis, while the quantitative component comprised descriptive network analysis based on structural measures of connectivity, centrality and clustering. The qualitative findings show that network strategies are adaptive and situational, shaped by resource constraints, organisational routines, and network development rather than by explicit strategic plans. Bonding strengthened trust and existing relationship, clustering enabled task-focused collaboration, formalisation supported continuity through established routines and bridging emerged largely unintentionally through routine coordination. Professionals combined strategies flexibly, resulting in hybrid strategic repertories rather than distinct strategy types. Integration of qualitative and quantitative data revealed only partial alignment between reported strategies and observed structures. Crucially, professionals themselves did not always recognise the structurally prominent brokerage positions they held, indicating that brokerage is an emergent feature of everyday networking. These findings suggest that municipal health promotion cannot be characterised by a single form of professional collaboration. Rather, collaboration must adapt to the task at hand, ranging from information exchange and multiprofessional collaboration to intersectoral collaboration. In order to sustain relationship-based collaboration while retaining the flexibility to respond to local needs and health inequities, municipal health promotion requires institutional support for coordination.