Imagining the flowers, but working the rich and heavy clay: participation and empowerment in action research for health

Abstract

Participation of the ‘target group’ is a key concept in working on empowerment in health education. However, it raises many questions and is not without struggle. I will discuss the findings from a study into the state of the art of empowerment in health education, which includes a literature review and the analysis of eight Dutch health‐promotion projects. An important finding is that participation is not an unequivocal concept. Professionals working in health education strongly disagree on the value, goals and meaning of participation. Moreover, in working on empowerment, a tension exists—between the ideal of participatory, ‘bottom‐up’ approaches on the one hand; and the ‘top‐down’ structure of health education programmes, on the other. I will argue for a ‘realistic approach’ in which the practice of health promotion is taken as the starting point to work on empowerment. After all, imagining the flowers is easy, but working the rich and heavy clay is the challenge.