Migrants and ethnic minorities are under-represented in spaces created to give citizens voice in healthcare governance. Excluding minority groups from the health participatory sphere may weaken the transformative potential of public participation, (re)producing health inequities. Yet few studies have focused on what enables involvement of marginalised groups in participatory spaces. This paper addresses this issue, using the Participation Chain Model (PCM) as a conceptual framework, and drawing on a case study of user participation in a Dutch mental health advocacy project involving Cape Verdean migrants. Data collection entailed observation, documentary evidence and interviews with Cape Verdeans affected by psychosocial problems (n=20) and institutional stakeholders (n=30). We offer practice, policy and theoretical contributions. Practically, we highlight the importance of a proactive approach providing minorities and other marginalised groups with opportunities and incentives that attract, retain and enable them to build and release capacity through involvement. In policy terms, we suggest that both health authorities and civil society organisations have a role in creating 'hybrid' spaces that promote the substantive inclusion of marginalised groups in healthcare decision-making. Theoretically, we highlight shortcomings of PCM and its conceptualisation of users' resources, suggesting adaptations to improve its conceptual and practical utility. © 2015 Elsevier Ltd.

Marginalised groups Netherlands Mental health User involvement Public participation Participation chain model ethnic minorities

Netherlands participatory approach social exclusion public health service health care policy nonbiological model Consumer Participation Cape Verde motivation mental health human minority group participation chain model middle aged population group marginalized group stakeholder Aged social interaction psychosocial disorder procedures mental health care qualitative research consumer advocacy Humans migrant conceptual framework Minority Groups male female clinical article Social Stigma health services patient education Article awareness social participation adult health care access Health Policy decision making empowerment Healthcare Disparities ethnic minority health care disparity public health