1. Analytical Summary
Context, issues and targeted audiences
The guide starts from the observation that citizen participation has become a central lever for acting on the social determinants of health, reducing inequalities, and strengthening the legitimacy of public health policies. It is based on the Ottawa Charter, a Quebec experience of co-construction of the National Public Health Programme 2025-2035 with nine citizens, as well as on robust literature in patient partnership and social participation. The document targets public health actors (professionals, managers, decision-makers, community organisations) wishing to integrate participation into the planning, implementation, and evaluation of their actions. It describes the essential values (integrity, transparency, equity, diversity, inclusion, accountability) and the risks of symbolic participation, emphasising the need to share power and recognise the plurality of knowledge.
Operational contributions for practices
On an operational level, the guide provides a clear continuum of participation levels (from information to citizen leadership) and specifies, for each, examples of concrete methods to mobilise. It offers a structured tool for strategy development (sections 1 to 6) that allows for framing objectives, profiles, working methods, support for participation, and continuous improvement, with directly usable guiding questions. The appendices detail models of mandates for partner citizens, follow-up questionnaires for citizens and professionals, an analysis of barriers to involvement, and action pathways in case of conflict. The document emphasises the need to allocate a compensation budget, make logistical adjustments, and provide specialised support, while also offering recent Quebec resources for further development (reference frameworks, training, compensation guidelines).
2. Key points of the document
Clarification of the participation continuum and levels of shared power
The guide formalises a continuum ranging from non-participation to citizen leadership, inspired by Arnstein and adapted to public health, by identifying the real margins of influence of citizens at each level. It describes the risks of symbolic participation and emphasises the need to adapt the level of engagement to preferences, constraints, and contexts, clarifying the conditions required to aim for a genuine partnership. (p. 9, 14–15)
Rigorous preparation of the approach and shared definition of objectives
The preparation phase is presented as crucial: clarifying the 'why, when, and how' of participation, explaining institutional constraints, defining expected outcomes, and valuing all types of knowledge (experiential, professional, scientific). Examples of objectives (adapting an intervention, strengthening commitment, integrating underrepresented voices) and reflective questions support the formulation of credible strategies. (p. 10–11, 22–23)
Recruitment and support of a diverse range of citizen partners
The guide proposes criteria for identifying citizen partners, warns against the overrepresentation of the most available profiles, and recommends aiming for parity with other involved actors or, failing that, a minimum of three citizens. It details good recruitment practices (varied channels, trusted intermediaries, support for individuals with low literacy or in precarious situations) and nuances expectations according to forms of participation (consultation vs leadership). (p. 11–14, 23–24)
Winning conditions for implementation and institutional support
A series of structuring conditions is described: explicit institutional support, shared vision, accessible vocabulary, designation of a trained resource person for partnership, time dedicated to informal exchanges and continuous adjustment. The guide emphasises the importance of anticipating logistics (schedules, accessibility, digital support), providing compensation and reimbursement of expenses, and formalising commitments to confidentiality and feedback to citizens. (p. 16–19, 26–29)
Tools for evaluation and continuous improvement of the partnership
The document encourages regular evaluation of the outcomes and the participatory process through questionnaires and dedicated meetings, relying on the strategy tool and several annexes (citizen and facilitator questionnaires, collaboration preparation list). It proposes ways to document the perceptions of different members, analyse the impact of participation on decisions, and inform future approaches, including through structured conflict resolution. (p. 20, 29–30, 33–38)
3. Action points for local stakeholders
Systematically structure projects using the strategy tool (p. 22–30)
For any new project (or the revision of an existing action), use the citizen participation strategy development tool as a project sheet skeleton: clarify from the outset the objectives, deliverables, desired profiles, level of engagement, and modalities of participation. This structuring allows a public health department, an association, or a CCAS/CIAS to anticipate resource needs, key partners, and monitoring arrangements, integrating partnership as a non-negotiable component of the project.
Establish formalised involvement mandates for partner citizens (p. 31–32)
Draw inspiration from the involvement mandate model to specify expectations, tasks, duration, selection criteria, and compensation modalities for each project, in co-construction with citizens and teams. This formalisation is particularly useful for medical-social or associative structures that recruit peer supporters or user representatives, and reduces misunderstandings about roles and responsibilities.
Set up a minimal monitoring and mutual support system (p. 33–36)
Deploy the proposed follow-up questionnaires for citizens and for facilitators/interveners in order to regularly gather successes, challenges, and the level of comfort in their roles. For a local prevention team or a neighbourhood council, these tools allow for continuous adjustment of the modalities (pace, content, support) and to objectify difficulties (fatigue, misunderstandings, tensions) before they compromise the partnership.
Identify and explicitly address the barriers to participation (p. 16–18, 37)
Use the list of barriers (practical, financial, power-related, cultural, structural) as a checklist when preparing each initiative, cross-referencing it with local realities (rurality, precariousness, language barriers, discrimination). Local actors can derive concrete measures from this: transport budget, adapted schedules, language mediation, simplification of procedures, digital support, or individual assistance.
Anticipate the management of tensions and conflicts as a component of the project (p. 18–19, 38)
Integrate, from the outset, mediation mechanisms inspired by action pathways in case of conflict: identified neutral third party, shared analysis of facts, clarification of roles and power dynamics, resorting to 'unusual' solutions. This approach is particularly relevant for initiatives involving sensitive issues (health inequalities, discrimination, organisational changes) where disagreements are frequent, and it protects the trust of the involved citizens.
4. Additional references
🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of participation ➡️🔗 🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of parenting ➡️🔗
Government of Quebec –Government framework on public participation(final version)
This framework provides seven guiding principles for designing, implementing, and evaluating public participation approaches, in strong alignment with the values and conditions described in the guide.
Institute of the New World –Citizen participation in health: some guidelines(training, 2024)
Online training that situates public participation in health within its political and legal environment, presents the “rules of the trade” and the challenges, useful for complementing the training dimension of the guide.
URL :https://inm.qc.ca/formation-la-participation-citoyenne-en-sante-quelques-reperes/
Fox G. et al. (2024) –What guidance exists to support patient partner compensation practices? A scoping review of available policies and guidelines(Health Expectations)
Review of international policies and guidelines on patient partner compensation, directly related to the section of the guide on the recognition and remuneration of citizen knowledge.
Summary and access: via DOIhttps://doi.org/10.1111/hex.13970
5. Cross-sectional analysis — Values of health practices
Literacy: The guide provides guidelines for accessible language, recommends the development of a co-constructed lexicon, and raises awareness of the low health literacy of certain populations, while not providing ready-to-use plain language materials.
Empowerment: The approach explicitly aims at developing the capacity of communities to act, involving citizens in defining objectives, priorities, and decisions, particularly at the levels of collaboration, partnership, and citizen leadership.
Participation: The document describes concrete mechanisms for co-construction (working groups, co-chaired committees, deliberative forums) and equips the structuring of a continuous citizen presence rather than merely consultative.
Community health: The collective dimension is strongly integrated through consideration of living environments, social determinants of health, and knowledge from various community groups, including those that are usually underrepresented.
Ethics: The authors identify risks of symbolic participation, over-representation of certain groups, and power imbalances, and propose safeguards (parity, transparency, compensation, reflexivity).
Human rights: The guide emphasises equity, diversity, and inclusion, particularly integrating migrants with precarious status into the definition of "citizens," which aligns with a human rights approach.
Intersectorality: It mentions numerous consulted associative and institutional partners, and recommends collaborations with community organisations, municipalities, and sectoral networks for recruitment and anchoring of initiatives.
Partnership: Models of collaboration are realised through the strategic tool, engagement mandates, follow-up questionnaires, and examples of shared governance inspired by the Montreal model of patient partnership.
Combating discrimination: The document subtly addresses discrimination and inequalities (social, economic, cultural, linguistic), emphasises non-judgement, the representation of minority voices, and adaptation to the specific constraints of marginalised groups, while not proposing a detailed anti-discrimination framework.
6. Evaluation of the reliability of the resource
Scientific relevance
The guide is based on recognised international and Quebec literature (Arnstein, OECD, studies on the impact of participation, prevention frameworks, work on the compensation of partner patients), clearly referenced in footnotes and in Annex VI. It is produced by legitimate academic and public health institutions (CEPPP, ASPQ, University of Montreal, CIUSSS) and updated until 2025-2026 (OECD references 2025, training 2024, articles 2024 on compensation). The methodology of development (cross-referencing literature, field experience PNSP, consultations with organisations) is explicit, which enhances its credibility.
Operational relevance
The document is highly operational: it offers a structured strategy tool, mandate templates, questionnaires, a list of obstacles and conflict resolution pathways, as well as examples of modalities by level of participation. It is designed to be adaptable and reusable in various contexts (local projects, regional programmes, institutional arrangements), integrating constraints of time, budget, organisation, and professional culture. The presence of updated complementary resources facilitates the appropriation and updating of practices.
7. MCQ — 5 questions
Part 1 — Questions (without answers)
Question 1 (pp. 8–9)
In the guide, what is the main objective of citizen participation in public health?
a) To reduce the implementation time of projects
b) To better understand and act on the determinants of health and inequalities, by strengthening the legitimacy and sustainability of actions
c) To increase the media visibility of health institutions
d) To replace professional expertise with experiential knowledge
Question 2 (pp. 11–13)
According to the guide, what major risk is associated with the involvement of a single citizen in an institutional group?
a) A systematic increase in the project budget
b) A high risk of non-compliance with administrative deadlines
c) An imbalance of power and representation that could lead to the instrumentalisation of their voice
d) A decrease in motivation among public health professionals
Question 3 (pp. 14–16)
In the presented continuum of participation, which of the proposals corresponds to the level of “partnership”?
a) Citizens are informed about the project but do not participate in decisions
b) Citizens are consulted occasionally to give their opinion on a service
c) Citizens co-chair a steering committee and participate in decisions throughout the project
d) Citizens carry out actions on their own, without institutional support
Question 4 (p. 16–18, 27–29)
Which of the following elements is not mentioned in the guide as an obstacle that could hinder citizen involvement?
a) Time and scheduling constraints
b) Language or cultural barriers
c) Lack of financial compensation or coverage of costs
d) Excessive flexibility in public health organisational structures
Question 5 (p. 20, 29–30, 33–36)
What tool or device does the guide propose to support the evaluation and continuous improvement of participatory approaches?
a) A single scoring scale for partner citizens
b) Separate follow-up questionnaires for partner citizens and for facilitators/experts
c) A mandatory external audit every three years
d) A framework of sanctions for teams that have not achieved citizen/professional parity
(Letter of the correct answer: Q1=b, Q2=c, Q3=c, Q4=d, Q5=b — overall order: b / c / c / d / b, with b used twice, in accordance with the instructions.)
Part 2 — Commented correction
Question 1:
In the guide, what is the main objective of citizen participation in public health?
✅ Correct answer: b) To better understand and act on the determinants of health and inequalities, by strengthening the legitimacy and sustainability of actions.
📝 Explanation: The introduction defines citizen participation as a strategy to better grasp the determinants of health, their interactions, and inequalities, and to co-construct more legitimate, effective, and sustainable interventions. Source: p. 8–9.
Question 2:
According to the guide, what major risk is associated with the involvement of a single citizen in an institutional group?
✅ Correct answer: c) An imbalance of power and representativeness that may lead to the instrumentalisation of their voice.
📝 Explanation: The guide warns that a single citizen in a group, especially an institutional one, finds themselves in an isolated position, with a risk of minimisation or instrumentalisation of their contribution, which undermines the approach. Source: p. 12.
Question 3:
In the presented continuum of participation, which of the proposals corresponds to the level of “partnership”?
✅ Correct answer: c) Citizens co-chair a steering committee and participate in decisions throughout the project.
📝 Explanation: The 'partnership' level implies a real sharing of decision-making power, from the beginning and throughout the duration of the project, which the guide illustrates with examples of co-chairing and co-construction of action plans. Source: p. 14–16.
Question 4:
Which of the following elements is not mentioned in the guide as an obstacle that could hinder citizen involvement?
✅ Correct answer: d) Excessive flexibility in public health organisational structures.
📝 Explanation: The identified obstacles are more related to structural rigidities, time constraints, financial barriers, power dynamics, or linguistic and cultural barriers; excessive flexibility is not mentioned. Source: pp. 16–18, 37.
Question 5:
What tool or device does the guide propose to support the evaluation and continuous improvement of participatory approaches?
✅ Correct answer: b) Separate follow-up questionnaires for partner citizens and for facilitators/experts.
📝 Explanation: Appendices II and III provide two follow-up questionnaires, one for partner citizens and the other for facilitators/experts, in order to document perceptions, difficulties, and learnings and to continuously adjust the approach. Source: pp. 20, 33–36.
8. Frequently Asked Questions (FAQ)
Who is the target audience for this guide? (pp. 3–4)
The guide is aimed at public health actors who wish to work in partnership with citizens in the planning, programming, implementation, and evaluation of their actions. This includes regional and local teams, managers, decision-makers, and community partners.
At what point in a project is it preferable to involve citizens? (pp. 10, 14–15, 24–25)
The guide recommends involving citizens as early as possible, from the design stage, to co-define the objectives, expected outcomes, and framework of shared values. Later involvement is still possible but must ensure real influence at the chosen stage.
How many partner citizens should be involved to avoid isolation? (p. 11–12)
It is advised to aim for parity between citizens and other stakeholders; failing that, a minimum of three partner citizens is recommended to avoid isolation, support speaking up, and enable peer exchanges.
How to recruit citizens from underrepresented groups? (p. 12–14, 23–24, 37)
The guide recommends reaching out to the public through various channels (community organisations, social media, living spaces), relying on trusted intermediaries, and adapting the methods (support, language, time, locations) to account for specific barriers (literacy, language, precariousness).
Should partner citizens be compensated, and how? (p. 16–17, 27–28, 39–40)
Providing compensation is strongly recommended to recognise the value of citizen knowledge and remove barriers to participation, discussing suitable forms (financial, gift cards, meals, transport costs). The guide refers to recent guidelines and reviews on compensating partner patients.
How to ensure that participation is not 'symbolic'? (p. 9, 14–16, 18–19, 29–30)
It is essential to clarify from the outset the level of engagement and influence of citizens, to document the contributions accepted or not, to provide transparent feedback, and to adjust the methods based on the feedback. The use of the strategic tool and follow-up questionnaires helps to objectify this non-symbolic nature.
What tools does the guide propose to structure and evaluate a participatory approach? (pp. 22–30, 31–36)
The guide offers a strategic tool in six sections, a model for an engagement mandate, follow-up questionnaires, a collaboration preparation checklist, and an inventory of obstacles and action pathways in case of conflict. These tools are directly reusable or adaptable to local contexts.
9. Rewriting in Easy-to-Read Language
Title
Towards Participatory Public Health – Practical Guide.
Easy-to-Read Summary
Context and Issues
Public health aims to address the causes of diseases and inequalities.
The guide states that the voice of citizens is important for better action.
Citizens, professionals, and researchers all have useful knowledge.
They must work together to decide on health actions.
The guide targets public health teams and grassroots associations.
It provides a framework for involving citizens from the beginning to the end of a project.
Operational Contributions
The guide explains several levels of citizen participation.
For example: informing, consulting, collaborating, deciding together, or providing leadership.
He provides simple questions to prepare each stage of a project.
He offers document templates to invite and follow up with citizens.
He discusses practical obstacles and ways to reduce them.
He explains how to assess and improve participation during and after the project.
Key points FALC
Prepare the approach
It is important to clearly state why we want citizen participation.
It is necessary to explain what citizens can really change in the project.
Everyone must understand the objectives in simple terms.
Recruit diverse citizens
One should not invite just one citizen in a large group.
It is important to seek people with different life experiences.
One should reach out to people in their living spaces and networks.
Adapt the conditions for participationIt is necessary to choose suitable times for citizens.
Support should be provided for transport, childcare, or digital needs if necessary.
Clear language should be used, and acronyms and technical terms should be explained.
Recognise the time and knowledge of citizensIt is important to provide fair compensation for the time given.
Compensation can be money or other suitable forms.
Expenses such as transport or meals should also be reimbursed.
Evaluate and improve participationRegularly seek the opinions of citizens and professionals.
The guide provides simple questionnaires for this.
This feedback is used to change the way we work together.