Unpacking Assumptions About Inclusion in Community-Based Health Promotion: Perspectives of Women Living in Poverty

Abstract

Community-based health promoters often aim to facilitate “inclusion” when working with marginalized women to address their exclusion and related health issues. Yet the notion of inclusion has not been critically interrogated within this field, resulting in the perpetuation of assumptions that oversimplify it. We provide qualitative evidence on inclusion as a health-promotion strategy from the perspectives of women living in poverty. We collected data with women engaged in a 6-year community-based health promotion and feminist participatory action research project. Participants’ experiences illustrated that inclusion was a multidimensional process that involved a dynamic interplay between structural determinants and individual agency. The women named multiple elements of inclusion across psychosocial, relational, organizational, and participatory dimensions. This knowledge interrupts assumptions that inclusion is achievable and desirable for so-called recipients of such initiatives. We thus call for critical consideration of the complexities, limitations, and possibilities of facilitating inclusion as a health-promotion strategy.