Theorizing participation in health promotion: A literature review

Participation is a key principle in health promotion. Numerous methods and tools are available and several models are used to guide and evaluate participatory endeavours in the health field. Recently, however, the lack of conceptual clarity and the normative underpinning of participation have been criticized and more substantiation by social theories has been suggested. To identify theoretical approaches applied to the topic so far and elaborate their potential contribution, a systematic literature review was conducted. Very few papers were identified that included substantial use of social theories. Their main arguments were grouped and critically discussed within a framework of three key questions. The first analyses the functions of participation and expands either the ‘democratic' or ‘utilitarian' perspective commonly suggested. The second asks how lay actors can be constituted as interested and competent stakeholders within their socio-political environments. The third complements an actor-focused perspective by elaborating participatory processes as asymmetric and conflictual. We conclude that the theoretical contributions available offer relevant stimulation for the conceptualization and implementation of participation in health promotion. Future theoretical work could benefit from cross-fertilization with theoretical debates in other areas of health promotion and from more explicitly elaborating the social context within which participation takes place.