Co-creating community initiatives on physical activity and healthy eating in a low-income neighbourhood in Quito, Ecuador

Abstract Promoting healthy behaviours to improve population health requires strategies that foster supportive environments and actively engage communities. Here, we detail an evidence-informed co-creation process in Ferroviaria, a low-income neighbourhood in Quito, Ecuador, led by six members of a local Women’s Association. Co-creation here involved a participatory approach that integrated local epidemiological data on non-communicable disease (NCD) risk factors and employed the "Dialogue Forum" methodology to guide collective decision-making. Through this process, community leaders and participants prioritized initiatives based on community needs, ultimately choosing to develop a community food garden. This initiative fostered social confidence, empowerment, and cohesion, though challenges emerged, including limited participation in the evaluation phase and difficulties in sustaining actions post-implementation. We demonstrate how the "Dialogue Forum" can be an effective tool for inclusive decision-making in low-resource settings. For future co-creation efforts, we underscore the importance of building strong local networks and implementing strategies to prevent dominance by either community leaders or researchers within the co-creation process. Initiatives should incorporate comprehensive community-led evaluations, and it is critical for community leaders to understand the importance of developing actions that the community can independently lead and sustain without continued institutional support. When health data is used, it should be framed to emphasize contextual determinants rather than focusing solely on behavioural risk factors. This report contributes to the growing evidence on community-driven health interventions, positioning co-creation as a pathway to social change and enhanced public health outcomes.