“Challenging but worth it!”: The purpose of participatory research in urban health, an evaluation and derived framework

Participatory approaches are becoming paramount to harness the relationship between researchers, government, industry, and civil society to inform programs and policies. However, variability in implementation and limited standardized reporting hinder the systematic evaluation of their effectiveness. This study characterizes participatory methodologies in urban health research and proposes a framework for evaluating and reporting such approaches. Using an explanatory sequential design, this study evaluated 20 participatory pilot studies from the Urban Health Cluster (Horizon 2020 European Commission Programme), combining survey data and semi-structured interviews with project leads. The analysis identified four primary purposes for participatory methods: to assess health-environment correlations; raise awareness; co-create interventions; and assess health-related effects. Case studies exemplify each of these purposes. Findings informed a “purpose framework” nested within a theory-of-change model, which clarifies the rationale behind participatory approaches and maps their processes and intended impacts. The framework includes indicators for purpose, stakeholder involvement, participation mechanisms, facilitators, challenges, expected outcomes, and evaluation strategies, reported across all 20 projects. Public authorities (90 %) and civil society (85 %) are the most frequently engaged stakeholders, typically involved during project identification and deployment. Engagement was facilitated by shared motivation to address local needs, while long-term commitment posed challenges. Our results highlight the limited use of theory-of-change models in current practice and the value of structured frameworks for enhancing the reproducibility and transformative impact of participatory urban health research. The proposed framework can help align participatory methods with a theory of change and foster more effective urban health transformations.