Abstract

Aim
The aim of this paper is to examine how mechanisms influencing participation and sustained engagement operate in community-based obesity prevention interventions. Using a realist cross-case analysis of three public health programmes, the study explores how programme resources interact with contextual conditions to trigger stakeholder reasoning that supports recruitment, implementation, and programme continuity.
Methods
A systematic literature review was conducted to identify interventions aimed at sustainably preventing overweight and obesity. Interventions were selected according to the Obesity Systems Influence Diagram and additional feasibility criteria. Three programmes were chosen as case studies: Healthy Weight Communities (Scotland), Movement as Investment in Health (Germany), and Walking for Health (England). A case-study design was employed for each intervention. Semi-structured interviews were conducted with twenty-six stakeholders involved in programme implementation, complemented by participant observation and secondary document analysis. Data were analysed using realist evaluation logic to develop and refine context–mechanism–outcome (CMO) configurations.
Results
Cross-case analysis identified mechanisms influencing participation and programme implementation that operated through stakeholders’ interpretation of programme resources within specific contextual conditions. Recruitment and sustained engagement were supported where intervention activities were framed in ways that enabled participants to perceive participation as socially meaningful, accessible, or professionally legitimate. Organisational flexibility, participatory planning processes, and locally embedded relational resources contributed to engagement by reducing perceived social risk and strengthening trust in programme delivery. These mechanisms supported participation, programme continuity, and the expansion of intervention activities across the three cases.
The analysis followed a retroductive logic, moving iteratively between empirical observations and theoretical explanations to identify underlying mechanisms.
Conclusions
The findings suggest that participation and sustained engagement in community-based obesity prevention interventions depend not only on the availability of programme resources but also on how those resources are interpreted by participants and implementers within their social and organisational contexts. By applying a realist cross-case analysis, this study highlights mechanisms through which programme resources trigger stakeholder reasoning that supports recruitment, engagement, and implementation. Understanding these mechanisms can inform the design and evaluation of public health interventions that seek to achieve sustained community participation in complex social environments.