Adoption of positive health and related concepts in practice

Abstract

Introduction:In 1948, the World Health Organization defined health as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’. More recently, broader concepts of health are being adopted, such as Positive Health. This movement has led to a bigger emphasis on people’s abilities rather than their limitations. In the Netherlands, a wide range of initiatives is taking place in which a broad concept of health is being adopted. These initiatives include different types of organizations and collaborations of organizations (e.g. health and social care organizations, municipalities) that use the concept to optimize health and social care delivery and ultimately improve health outcomes. The aims of our study were: 1. to identify the initiatives that adopt a broad concept of health and 2. to understand the perspectives of different actors (i.e. policy-makers, health and social care professionals, citizens) on using a broad concept of health.Methods: Stakeholders from a wide range of initiatives received an online survey which focused on the initiatives’ characteristics (e.g. organizations involved, targeted populations, activities undertaken to operationalize the adoption of a broad concept of health). The survey was completed by 96 respondents, of which 15 were invited for an interview to understand experiences and perspectives on adopting a broad concept of health including its consequences for health and social care delivery and health outcomes.Results: Initiatives in which broad concepts of health were adopted took place in a wide range of settings (e.g. municipalities, health and social care providers, citizens, employers, schools, sporting clubs) and targeted a wide range of populations (e.g. older people, youth, employees, people with a low socio-economic status). Although respondents were highly motivated and positive about the adoption of a broader concept of health, at the same time they were struggling with how to adopt the concept at different levels of the health and social care system. More than 50% of the initiatives aimed to evaluate the impact of the adoption of the broad concept of health. However, most respondents found it difficult to capture impact and searched for appropriate evaluation methods and indicators for this context. Discussion, conclusion, and lessons learned: The adoption of broader concepts of health is a current issue in the Netherlands. Different types or organizations and stakeholders have embraced these concepts, but there is large variation in how the concepts are operationalized. There is an urgent need to exchange lessons learned, and to work towards meaningful indicators to measure experiences, outcomes and processes of working with a broader concept of health.Limitations:The majority of the stakeholders in our study adopted the Positive Health concept. Insight into the adoption of other concepts therefore remains limited.Suggestions for future research:A participatory action research approach is recommended in future studies targeted on the needs of the different stakeholders at different levels working with a broad concept of health. Such approaches will, through an iterative cycle of research, action, and reflection, further facilitate mutual learning.