This article presents and discusses the evaluation of the participatory process involved in the Local Plans for Health (LPH) of the Region Emilia-Romagna (North Italy). LPH are three-year plans of action that actively engage community members in collaborative decision making over health promotion interventions. The evaluation study conducted on the LPH 2001-2003 of Cesena, using a Participatory Action Research (PAR) approach, involved 34 community stakeholders, who took part in three focus groups. Themes discussed centered on the difficulties encountered in engaging all relevant community members, how to overcome such difficulties, and how to best communicate the results of the evaluation process to the population. Process evaluation was a central component of the planning of future plans.