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Objective: Citizen participation is one of the core values of Health Impact Assessment (HIA). Nevertheless, there is a gap between the ideal described in HIA foundational texts and its current practice as reported in the international literature. In the light of HIA recent development in France, this article provides some insights to better understand this concept and the challenges associated to its actual implementation in France. Methods: This exploratory study is based on semi-structured interviews, on-site observations and document analysis of a panel of 11 HIAs carried out in 8 French regions between 2011-2018. Citizen participation is analyzed according to 5 dimensions: stakeholders’ perceptions and expectations, scope of participation, scale, methods of engagement, constraints. Results: As reported in other studies published abroad, the concept of citizen participation remains unclear in France. Despite some progress observed in more recent HIAs, its actual implementation remains incomplete due to political, financial and human constraints and to competition with other existing mechanisms for public participation at a local level. Conclusion: While accumulated experience may contribute to effectively integrate citizen participation in HIA, this study shows that in order to better bond this practice to health promotion values, it is important to clearly define the objectives of such participation, to sensitize city counselors in advance, to strengthen HIA practitioners’ capacities, and to rely on participation specialists.