Participatory approaches to promote healthy lifestyles among Turkish and Moroccan women in Amsterdam.

Although it is recognized that community health promotion succeeds or fails by level of participation, effectiveness and benefits of community programs are underestimated, because participation is seldom monitored and evaluated. In the Dutch "Healthy Lifestyle Westerpark" program in Amsterdam, participation was both the main working principle and the main goal.Between 2003 and 2006, the Municipal Health Service (MHS) carried out a qualitative study on the background of overweight in Turkish and Moroccan women aged 25 to 45 years and on possibilities for promoting health with and for the target group. The aim of the program was to increase the women's participation and to evaluate participation levels in all phases. The research aim of this paper is to contribute to the development of participatory methods.Needs assessment and intervention development phases resulted in implementation of aerobic lessons and nutrition interventions. In the evaluation phase, participation levels were measured using Pretty's typology in focus groups.Results show that women appreciate participating in the program. Increase in physical activity was not measured. Women's knowledge about healthy food increased, women changed behavior by buying healthier food ingredients and women continued to participate.Participatory approaches facilitate participation at the desired level in the different phases of the program. Participatory approaches are time-consuming but worthwhile. Pretty's typology is useful to measure degree of participation, although methods can be improved and the meaning of participation should be reconsidered.The added value of this article is twofold: 1. it demonstrates that participatory methods and tools both facilitate and evaluate participation, and 2. it shows how to evaluate the degree of participation.