Making the invisible visible: participatory sociograms for co-created health actions in Elche, Spain

Understanding how local actors relate and influence health is essential for equitable community health action. Traditional assessments often fail to capture relational dynamics, hindering context-aware planning and perpetuating invisible barriers in vulnerable settings. Interventions that do not reflect local networks risk low uptake and limited impact. Practical, transferable participatory approaches are needed to make these dynamics visible and inform the co-creation of initiatives. In 2025, participatory sociogram workshops were conducted in a diverse, low-income neighbourhood in Elche, Spain, to map actor networks and relationships as a foundation for co-creation. Participants (n = 90; 67 professionals, 32 community members: migrants, youth, older adults, and Roma) identified key community actors, positioned them on a matrix (power x health influence), and mapped relationships (collaboration, dependence, conflict, or absence). The project asked: 1)Who are the key actors and how are they connected? 2)Do perceptions differ across groups? 3)What strengths and weaknesses should inform the co-creation of interventions? Sociograms revealed contrasting perspectives. Professionals emphasised institutional structures and tensions, while community participants described isolation and prioritised non-clinical actors as key to health. Weaknesses included language and cultural gaps, lack of formal links between intercultural mediators and healthcare, and intersectoral fragmentation, alongside limited opportunities for intergenerational connection and socialisation. Strengths included informal networks, community and third-sector associations, and health-promoting community resources such as educational centres and social spaces. Participatory sociograms provide a practical, transferable approach to initiate co-creation by making visible diverse perspectives, power dynamics, and relational gaps. This supports more inclusive, context-adapted and equitable public health action.

Key messages

• Understanding community relational dynamics can strengthen intersectoral collaboration and improve the effectiveness of health interventions.

• Participatory sociograms transform community and institutional perspectives into a shared foundation for co-creation of context-sensitive and equity-oriented health action.