Community‐Led Pathways to Rural Health Equity: A Most Significant Change Evaluation in Armed Conflict‐Affected Territories in Colombia
Camilo A. Correal-Muñoz, Natalia Reinoso-Chávez, Mónica Alexandra Segura Esguerra, Valeria Castillo Guzmán, Francisco Lamus-LemusObjective
To document and analyze the transformative effects of the Management of Social Health Initiatives training program on community health participation.
Setting
Two conflict‐affected rural municipalities in Tolima, Colombia (Chaparral and Icononzo), where structural barriers to health access and limited opportunities for meaningful community participation persist.
Participants
76 adults from rural communities.
Design
A qualitative participatory evaluation using the most significant change approach. Following the training program, 76 participants organized into 20 village‐based groups collaboratively produced one narrative per group (20 narratives total). Thematic analysis examined contextual conditions, program mechanisms, and perceived individual and collective changes in community health participation.
Results
Participants reported transformations in both individual and collective health participation capacities. At the individual level, outcomes included increased self‐confidence, leadership, health literacy, and a revaluation of self‐care as health participation. At the community level, changes encompassed strengthened self‐management, social fabric, and sense of belonging. Narratives also documented cases of partnership building with local health authorities and improved civic agency. These changes were enabled by key pedagogical mechanisms.
Conclusions
Participatory training grounded in experiential learning and community dialog can foster transformative changes in health governance in rural contexts. By shifting perceptions of participation from passive consultation to active community self‐management, the program advanced toward building sustainable health leadership and social accountability. These findings underscore the potential of inclusive educational interventions to strengthen local capacities for health promotion and reduce rural health inequities.