Summary The term ‘participation’ appears frequently in both international health documents and the national and local health documents of China. However, in all these documents there have rarely been concrete explanations of what participation is, how it will happen and what advantages it will bring. Based on six years experience in applying PRA in the health field in China, this article describes two cases in which participatory approaches were employed to conduct health projects, in order to try to explore answers to these issues. It concludes that participation means the involvement of all stakeholders at an early stage, and the sharing of responsibilities and power openly among stakeholders through a process of communicating and negotiating. The article raises some key issues that emerge in the process of participation, such as where views of stakeholders differ strongly, whose voice is strongest and who makes the final decision. Is participation always appropriate? Finally the article discusses the feasibility of participation and explores constraints and prospects for participation in the current context of China.