Abstract
BackgroundSeveral health determinants are related to local conditions and prerequisites at community level. For this reason, strengthening community action has been one of five strategies implemented in health promotion since the end of the 1980s. Such action includes setting priorities, making decisions, planning strategies, and implementing them to achieve better health. The aim of this paper is to obtain a deeper understanding of content, organization and processes in the development of local health promotion.MethodsA qualitative multiple case study of four Swedish municipalities. The cases were analyzed in accordance with the principles of cross-case study analysis, and a content analysis of documents and interviews was conducted in two steps. First, a manifest content analysis was performed to identify present and former actors and measures. Thereafter, a latent content analysis was performed to investigate structures and processes in local contexts.ResultsThe results of the inductive content analysis showed development of local health promotion in three phases: initiation, action, and achievement. Strengthening factors were local actors, health statistics and events. Hindering factors were lack of resources and vague objectives. External factors, e.g. national policies, were not perceived as prominent influencing factors. Media reports were regarded as having had an influence, but only to some extent. The content of local health promotion has developed from ad-hoc lifestyle and behaviour-related actions into structural, intersectoral actions related to determinants of health.ConclusionsThe municipalities have organized and developed their health promotion targets, actions and priorities on the basis of local needs and prerequisites. The three phases in the identified health promotion processes were experienced and documented as being subject to greater influence from internal rather than external strengthening and hindering factors in their local contexts.
Highlights
Several health determinants are related to local conditions and prerequisites at community level
The recent practice of health promotion has emerged from a disease and risk prevention perspective, but has developed towards an approach based on health determinants [7]
Local health promotion’s content, organization and development What the four municipalities had in common in the 1980s was a lack of any formal organization or explicit strategy for health promotion
Summary
Several health determinants are related to local conditions and prerequisites at community level For this reason, strengthening community action has been one of five strategies implemented in health promotion since the end of the 1980s. A community’s social structures provide opportunities to reach out through already existing connections and organizations in a local environment to which people more can relate Such bonding enhances participation and engagement in community development [5,6]. Nutbeam and Harris [3] define community organization in terms of processes through which community groups are assisted in identifying common problems or goals, mobilizing resources, and in other ways developing and implementing strategies for reaching their collective goals When communities enhance their ability to identify, mobilize and deal with health problems, community capacity is strengthened
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