Involving Citizens in Integrated Care. Lessons Learned Through Participatory Action Research in Three Communities in the Netherlands.

Introduction: In response to rising healthcare demands, alternative health system models are needed. This study aims to investigate the development of community-involved, cross-domain networks, and to identify factors that facilitate or hamper their growth and sustainability. Methods: This participatory action research used purposive sampling to select three diverse networks. A multi-methods approach of document analysis, observations, dialogue and twenty semi-structured interviews across the networks was applied. The ESSA-framework (Exploring, Shaping, Strengthening, Anchoring) of network development was used to track progression across its stages. Reflexivity was ensured through discussions with the networks, an advisory board, and the study's steering committee. Results: All networks advanced by one ESSA phase; however, one only progressed in interprofessional collaboration. Key factors affecting network development included a shared sense of urgency and community, mode of collaboration, essential roles, and a mix of competencies. Discussion: The limited number of networks limits external validity, yet their diversity, and the mixed methods and reflexivity revealed profound insights into community-involved cross-domain network development. Conclusion: Community-involved cross-domain network development is complex and requires felt urgency, patience and perseverance from all participants. Early engagement of both professionals and citizens is required, supported by network leadership and change-agent skills to drive development.