In Participatory Quality Development, participation means not only “taking part”. It also includes ownership, i.e. the power to make choices in all important areas of life. This mans the power to define which health problems should be addressed through health promotion or prevention activities. The more influence people exercise in a decision-making process, the stronger is their participation.

This principle follows from the Ottawa Charter’s central demand to position citizens’ self-determination at the core of health promotion. This role for self-determination is also based on many years of debate in the fields of urban planning, and later also in development studies, about the role of citizens in the implementation of interventions aiming to improve their environment. This debate has been influenced significantly by the work of the US American Sherry Arnstein who attempted to explain the success of citizens’ groups in processes of urban planning in her seminal article published in 1969. In her conclusion she states that sustainable changes improving the day-to-day life of residents are only then realised when the residents have had the opportunity to influence their living conditions directly.

Participatory Quality Development places a major emphasis on ownership by target groups and service providers (particularly front line workers) because they are the stakeholders who possess local knowledge and who contribute significantly to the success of interventions. It is also these two stakeholder groups who are most often not included in the development of quality assurance processes.

Participation is not an “either/or” decision, but a developmental process. Self-reflection and successful local stakeholder collaboration promote the further development of participation in health promotion and prevention projects. Depending on the conditions in the project’s operating environment and the target group’s living conditions, participation can be realised to varying degrees. The task at hand is to find the appropriate level of participation for the prevailing conditions (see also Levels of Participation).