**2. Methods and participatory instruments for community-based health promotion**

The possibilities and methods for implementing this democratic right are as diverse as the levels of intensity of participation and civic involvement, if one wants to gradually approach the normative requirements as formulated by the WHO in its Ottawa Charter. In recent decades, different models, strategies, and procedures have been discussed, developed, and tested in practice in many policy areas and evaluated in subsequent scientific projects [4–6]. There is a wealth of experience from several decades of practical civic involvement and participation [3, 7], which has now also been extended to include the aspect of participation in health research [8–10]. A separate classification scheme is presented here as an example of the various similar models.

The ladder models for civic involvement in decision-making processes or participation in health promotion are helpful constructs for the discussion and evaluation processes involved in strategic planning of political programs and activities, which can also be transferred to programs for prevention and health promotion. The models try to make clear that real participation and involvement entail different levels of intensity with respect to authority to exert power. According to these models, it is therefore always necessary to determine how much decision-making power actually lies with the population groups involved and their legal actors in order to speak of participation, preliminary stages of participation, or nonparticipation. Participation is not understood as an either/or option but as a development process.

In addition to this normative and politically oriented assessment of participation and civic involvement, a number of practical and creative methods and procedures for the participation of citizens and/or professional actors have developed in recent decades within the framework of urban planning and redevelopment processes, from project development and action planning to the formulation and implementation of political programs in different fields of action and policy areas. In addition, significant momentum for the development and further development of procedures and methods also came from the field of health promotion and prevention, not least through the Gesunde Städte (Healthy Cities) project. The German Healthy Cities network has a so-called 9-Points-Program of self-commitments. This document has to *Participation as a Core Principle of Community Health Promotion: General Account… DOI: http://dx.doi.org/10.5772/intechopen.111930*


#### **Table 1.**

*Traditional and creative methods of communication and involvement.*

be signed before becoming a member city. Point 5 requires that the city has to provide a framework that guarantees that all citizens "can participate in the shaping of healthy living conditions and environments." Point 7 requires, that in the steering committees of the cities there has to be at least one representative of local citizen initiatives or self-help groups.1

The list in **Table 1** provides a brief overview, without evaluation initially, of what can be "done today" in the areas of civic involvement and participation in the interests of the above-mentioned ladder models. The extent to which political decision-making processes can be influenced or even shaped shall not play a role at this point. It is important to note that participation and involvement always also require that the citizenry, or the particular neighborhoods or groups of the community concerned, generally have to be activated in some form in order to "participate" in participatory processes. This means that the methods and procedures used are always also about activation for participation and about the participatory process itself.

According to a study by the German Youth Institute [11] on the activation and participation of families, these methods and procedures can be differentiated between in terms of traditional and creative instruments of communication and involvement. These are listed in **Table 1** and supplemented for this paper by a number of other known participatory instruments.

In the socio-political process, for example, at the municipal level, a mix of traditional and creative instruments is often found, depending on the needs, the subject matter, and the desired solution to the upcoming problems and decisions.

The individual techniques, procedures, and methods mentioned here cannot and should not be discussed at this point. The focus of our remarks is intended, rather, to be on examples of participatory community-based health promotion as addressed and implemented in a disadvantaged district of Hamburg-Eimsbüttel by the local health office.

The practical project, which is accompanied by continuous research, was entitled "Lenzgesund" ("Lenzhealthy," tying in with the name of the district, "Lenzsiedlung" (the Lenz estate)).

<sup>1</sup> https://gesunde-staedte-netzwerk.de/wp-content/uploads/9-Punkte\_Programm.pdf
