How Does Health Promotion Work? Development of a Logic Model in the Austrian Context

Traditionally, health protection and health promotion activities have operated independently of each other in the workplace. Health protection has usually been viewed as encompassing the activities that protect workers from occupational injury and illness ranging from basic safety training to the us

Issue French public health authorities increasingly rationalize access to public funding, favoring evidence-based programs. Health Promotion (HP) interventions are especially urged to prove their efficiency in this context. To tackle this issue, HP practitioners hold experiential knowledge (EK) that proves useful to assess both the complexity and efficiency of HP interventions. United by this conviction in a multidisciplinary coalition, HP experts from various backgrounds came together five years ago to promote Experiential Knowledge in HP (EKHP) in France. A national committee to promote EKHP 670 HP practitioners were surveyed in 2016. Results reported vast amounts of under-documented and often untapped field expertise in HP and numerous obstacles regarding access to scientific literature or systematic reviews. Consequently, the coalition launched a National Committee for EKHP, meeting 5 times a year since 2016. Members of 6 national HP organizations, of 4 regional HP institutes, national and local public health administrators, researchers, consultants and field workers participate. Steered by the French Society for Public Health and the National Federation for Health Education and Promotion, the committee devised a threefold action plan: 1/ advocate EKHP in all relevant institutional spaces, 2/ develop tools for EKHP, 3/ mobilize for EKHP at the local level. Results The committee designed a method for capitalizing, collecting and circulating EK and published in 2020 a guidebook and a toolkit. French Public Health authorities agreed to share EK nationwide on their online portal. Dissemination within the French HP community has started, through the committee members' networks, and will be amplified with a training program launched in 2021 at the National School of Public Health. Lessons Attention must be brought to HP practitioners’ experiential knowledge, both to recognize HP practitioners' expertise and to help improve the understanding of how HP interventions work. Key messages Experiential knowledge in HP remains undervalued and untapped in France. Dedicated practitioners, policymakers and researchers formed a multidisciplinary committee to promote and disseminate EKHP. A multilevel strategy combining advocacy and tool building can be effective at promoting experiential knowledge. A multidisciplinary coalition provided the necessary context-specific levers in France.

Introduction: In health promotion, we should use interventions established by evidence to be effective in improving the health of the community. This paper reviews the concepts, evaluation and use of evidence in health promotion. Methods: A literature search of evidence-based health promotion and evaluation of health promotion was conducted using Medline, Social Science Citation Index (SSCI), PsycLIT and evidence-based web sites on health promotion, health education and community preventive services. Recent issues of key journals on health promotion, health education and public health were also hand-searched. Results: The concept of evidence in health promotion interventions is complex due to its multidimensional nature. Evidence of effectiveness in health promotion is assessed by combining quantitative data on effect change in outcome measures and qualitative data on process evaluation of health promotion activities. Limitations to the use of randomised trials in community-based health promotion interventions include ethical and logistic problems in maintaining randomisation of subjects over long periods, absence of experimental conditions in the real-world setting, contamination of control subjects and the multidimensional nature of health promotion interventions. Conclusion: Randomised controlled trials should be used to evaluate the effectiveness of most health education and behavioural interventions in clinical settings. When such trials are not feasible as in community-based health promotion interventions, quasi-experimental designs provide strong evidence. Multiple methods are needed to assess evidence of effectiveness of health promotion programmes. Appropriate practice of evidence-based health promotion requires consideration of quality of available evidence, local values and prevailing resources.

This paper reports a study describing community nurses' health promotion work with older people aged 50 years and above, and exploring particular health promotion initiatives for older people that would have transferability potential. With the ageing of populations worldwide, community nurses in primary healthcare settings have a key contribution to make to the health improvement agenda for older people, yet little is known of the extent of this aspect of their work. Questionnaires were sent to 1062 community nurses in six Scottish National Health Service Boards - public health nurses/health visitors, district nurses, general practice nurses, community psychiatric and learning disability nurses and combined duty nurses; 373 (35%) responded, 30 of whom were interviewed by telephone. The data were collected in 2003-2004. Findings confirmed the wide scope of health promotion, much of which may be embedded and unrecognized. Creative group work showed promise in achieving heath gain for older people, and a range of partnership approaches - interdisciplinary, multidisciplinary and interagency - was evident. Theoretical input and project opportunities within educational programmes had been a catalyst for health promotion initiatives in practice. However, evidence of audit, evaluation, and active involvement of older people in planning health promotion was limited. Funding of health promotion initiatives was vital to sustainability. There is merit in making the health promotion work of community nurses more visible through audit and systematic evaluation; promoting the active involvement of older people; strengthening partnership working; and further raising the profile of health in later life within undergraduate and postgraduate community nursing programmes.

Health promotion (HP) amongst older people is an increasingly prominent policy concern for governments. The development of an evidence-base and the advocacy of effective interventions in the light of this act as legitimation tools for the overall HP phenomenon – assisting the growth of state and non-state funding for public health initiatives for older people. In structuring decision-making as to which individual projects/initiatives receive funding, frameworks for acknowledging efficacy impact on formats of HP work both positively and negatively. Drawing on recent research across the EU and focusing on the specific national contexts of Austria and England, this comparative policy analysis triangulates best-practice modelling, evaluation data and interviews with project coordinators to explore how policy contexts impact on the nature and format of HP interventions. Amidst a developing awareness of what effective practice looks like, successful HP initiatives must advocate their legitimacy within narrow rules of quality, where measurable outcomes have become the keys which unlock financial resources. Findings across both countries suggest that this instrumentalisation of legitimation, driven by economic pressures and bureaucratic generalisability, threatens the rationality of HP. From a Habermasian perspective, tensions emerge between projects’ remaining reflexive towards processes and their need to articulate the ‘success’ of the interventions in a language of outcomes. Over time, in an era where resources are increasingly scarce and competition over these intensifies, a danger exists whereby the instrumentality of HP begins to separate from, and impinge upon, the capacity for projects to think and act holistically.

Purpose: The purposes of this study were to examine the differences in need, necessity, performance, barriers, and effectiveness of workers' health promotion program and to determine the influencing factors in effectiveness of workers' health promotion program by business types. Methods: Subjects were participants of an education held by Korean association of occupational health nurses and a survey was self-reported. Survey items were developed by researchers through literature review. It included general characteristics of occupational health providers and worksites, need, necessity, performance, barriers and effectiveness of workers' health promotion (WHP) program. The total number of worksites was 168, manufacturing/construction was 76 (45.2%), other services were 52 (31.0%), and healthcare services were 40 (23.8%). We used <TEX>${\chi}^2test$</TEX>, ANOVA test, correlation analysis, and multiple regression analysis. Results: There were differences in need, necessity and performance of WHP by business types. In healthcare services, WHP had statistically significant effectiveness to reduce turnover rates. And the influencing factors of WHP's effectiveness were workers' need in manufacturing/construction, health provider's career in other services, and perceived necessity in healthcare services. Conclusion: Based on this result, we propose differentiated strategies depending on the business types for effective workers' health promotion program.

Health promotion is informed by epidemiology, requires engagement with socially situated subjects and can involve diverging emphases. For some practitioners, health promotion is a specialised set of activities and technical knowledge for disseminating health information. For others, it advances broad-based and interlinked goals of socio-economic and health equality through processes of community engagement and participation. These diverging approaches are explored in qualitative data gathered from health promotion workers and residents involved in an area-based initiative that included aims to reduce health inequalities. The findings describe two distinctive approaches to health promotion that are characterised as ‘procedural’ and ‘cooperative’. Procedural styles, in the manner of ‘top down’ approaches, tend to differentiate between lay communities and professionals, involve predefined channels for community input, rely on ‘off the shelf’ health promotion packages and minimise the significance of local contexts. In contrast, cooperative styles are grounded in empathetic understanding of the impact of socio-economic and other disadvantages on everyday life, enact inclusive community engagement practices and develop ‘bottom up’, locally relevant health promotion initiatives. Noting the limitations of relying only on ‘top down’ or ‘bottom up’ approaches we argue that health promotion in community settings occupies a paradoxical space that is continuously negotiated by both health promotion workers and community residents. Further, health promotion workers need to be able to move between cooperative and procedural approaches in order to navigate the frequently conflicting demands of community, agency and professional expectations in order to achieve the best outcomes for communities.

BackgroundAlthough cardiovascular disease has decreased, there is still potential for prevention as obesity and diabetes increase. Exercise has a positive effect on many cardiovascular risk factors, and it can significantly reduce the components of metabolic syndrome. The main challenge with exercise in primary care is how to succeed in motivating the patients at risk to change and increase their exercise habits. The objective of this study is to modify the cardiovascular risk in middle-aged men, either through a health promotion intervention alone or combined with an exercise intervention.Methods/designDuring a two-year period we recruit 300 men aged from 35 to 45 years with elevated cardiovascular risk (> two traditional risk factors). The men are randomized into three arms: 1) a health promotion intervention alone, 2) both health promotion and exercise intervention, or 3) control with usual community care and delayed health promotion (these men receive the intervention after one year). The main outcome measures will be the existence of metabolic syndrome and physical activity frequency (times per week). The participants are assessed at baseline, and at 3, 6, and 12 months. The follow-up of the study will last 12 months.DiscussionThis pragmatic trial in primary health care aimed to assess the effect of a health promotion programme with or without exercise intervention on cardiovascular risk and physical activity in middle-aged men. The results of this study may help to plan the primary care interventions to further reduce cardiovascular mortality.The study was registered at the Controlled Trials (http://www.controlled-trials.com). Trial number: ISRCTN80672011. The study received ethics approval from the Coordinating Ethics Committee at Helsinki University Hospital on 8 June 2009 (ref: 4/13/03/00/09).

BackgroundFinnish schools are forerunners in promoting health for children, adolescents, and families, offering a range of dedicated services in schools to support this mission. Since services offered in schools can play a crucial role in promoting health amongst students and their families, it's essential to evaluate and improve these health promotion services to better meet the needs of users. School nurses are a vital part of the health promotive and preventive work, governed by law, offered to all students in Finnish compulsory schools. However, scarce research exists in a European context regarding the school nurses’ work in health promotion, especially focusing on their own experiences regarding health promotion actions.MethodsThis study investigates school nurses’ own views on their health promotive role, responsibility, and work in compulsory schools through qualitative interviews with school nurses (n = 13) in Finland, using qualitative content analysis guided by Granheim and Lundman.ResultsPreliminary results highlight the complexity of the school nurses’ work in Finnish compulsory schools. The tasks performed by the nurses vary from care assessments and health check-ups, to complex case solving in collaboration with different stakeholders. The school nurses highlight the importance of adopting a health promotive approach in every individual interaction, striving to provide children, adolescents and families with a low threshold contact available at school. They express the need to see and care for the students in a holistic way, including improving health and wellbeing at a general level in schools.ConclusionsThe study provides insight into the school nurses’ experiences regarding their role in providing health promotion in compulsory school settings. School nurses strive to have a health promotive approach in every encounter, wishing for more resources and time to get involved in health promotion on a general level in the school environment.Key messages• School nurses experience being a vital part of efforts aimed at improving health and well-being within the school environment, but request more time and resources for general health promoting actions.• By examining nurses’ views of their contribution to the students’ health promoting services, development opportunities can be located and examined to support nurses’ health promoting work in schools.

ABSTRACTBACKGROUNDHealth promotion programs and interventions are designed to encourage behavioral changes in children, encouraging them to make safe and healthy life choices. This systematic review seeks to examine how social impact is measured in primary school health promotion interventions.METHODA systematic search and review process was used to identify and examine primary school health promotion interventions. The PRISMA guidelines were followed to source articles from 6 electronic databases reporting school health promotion programs or interventions in Australia, Canada, New Zealand, or the United Kingdom.RESULTSA total of 77 studies were located, representing 55 health promotion interventions delivered in primary school settings. Of these interventions, only 8 (15%) measured or attempted to measure social impact, whereas another 8 (15%) alluded to social impact. The predominant theories reported were social based theories (theories which examine the social influences on people, environments, and behaviors) (n = 17, 59%), with almost a third not informed by an overt health promotion framework or model (n = 34, 59%). A systematic rating system identified some level of stakeholder engagement (n = 30, 53%).CONCLUSIONSThis systematic review highlights the need for social impact measurement within health promotion to illuminate the role of school programs in delivering lasting change.

BackgroundThe prevention of mental disorders and promotion of mental health and well-being are growing fields. Whether mental health promotion and prevention interventions provide value for money in children, adolescents, adults, and older adults is unclear. The aim of the current study is to update 2 existing reviews of cost-effectiveness studies in this field in order to determine whether such interventions are cost-effective.Methods and findingsElectronic databases (including MEDLINE, PsycINFO, CINAHL, and EconLit through EBSCO and Embase) were searched for published cost-effectiveness studies of prevention of mental disorders and promotion of mental health and well-being from 2008 to 2020. The quality of studies was assessed using the Quality of Health Economic Studies Instrument (QHES). The protocol was registered with PROSPERO (# CRD42019127778). The primary outcomes were incremental cost-effectiveness ratio (ICER) or return on investment (ROI) ratio across all studies.A total of 65 studies met the inclusion criteria of a full economic evaluation, of which, 23 targeted children and adolescents, 35 targeted adults, while the remaining targeted older adults. A large number of studies focused on prevention of depression and/or anxiety disorders, followed by promotion of mental health and well-being and other mental disorders. Although there was high heterogeneity in terms of the design among included economic evaluations, most studies consistently found that interventions for mental health prevention and promotion were cost-effective or cost saving. The review found that targeted prevention was likely to be cost-effective compared to universal prevention. Screening plus psychological interventions (e.g., cognitive behavioural therapy [CBT]) at school were the most cost-effective interventions for prevention of mental disorders in children and adolescents, while parenting interventions and workplace interventions had good evidence in mental health promotion. There is inconclusive evidence for preventive interventions for mental disorders or mental health promotion in older adults. While studies were of general high quality, there was limited evidence available from low- and middle-income countries.The review was limited to studies where mental health was the primary outcome and may have missed general health promoting strategies that could also prevent mental disorder or promote mental health. Some ROI studies might not be included given that these studies are commonly published in grey literature rather than in the academic literature.ConclusionsOur review found a significant growth of economic evaluations in prevention of mental disorders or promotion of mental health and well-being over the last 10 years. Although several interventions for mental health prevention and promotion provide good value for money, the varied quality as well as methodologies used in economic evaluations limit the generalisability of conclusions about cost-effectiveness. However, the finding that the majority of studies especially in children, adolescents, and adults demonstrated good value for money is promising. Research on cost-effectiveness in low-middle income settings is required.Trial registrationPROSPERO registration number: CRD42019127778.

Refugees resettling in the U.S. are generally low-income and underserved by health promotion interventions. To begin to address refugee health promotion issues, this study describes health behaviors of newly arrived (less than 90 days) adult refugees in the U.S. The methods used were retrospective description of clients from one refugee health screening program. The sample consisted of adult refugees (n=591), men and women, from Cuba, Bosnia, Vietnam, Kosovo, Iran, Iraq, and other countries. Rates of overweight were highest among Bosnians and lowest among Vietnamese. Cubans reported the most physical activity and Kosovars the least. Rates of smoking were highest among Bosnians and lowest among Cubans. Older refugees were more overweight and reported less physical activity and more smoking than younger adults. In some cases, different refugee groups have similar health promotion needs, while in others needs differ. This baseline descriptive data supports calls for further health promotion research and interventions in refugee populations.

This paper examines the epidemic of orthodoxy affecting the evaluation of current health promotion work. This has resulted in the privileging of certain methods, in particular, experimental method and the randomized control trial. Problems identified by public health researchers are discussed but the major focus of our critique concerns the ways in which the experimental method and, especially, the randomized control trial, assume that the audience of any health promotion message comprises a number of asocial individuals who occupy non-discursive space in ahistorical time. An alternative approach is advocated which focuses attention on the programme of health promotion and education rather than on any one individual health promotion initiative or intervention. Attention is also given to educational and health promotion practices; it is here, we argue, that some of the answers to ‘what works’ are to be sought. We illustrate our argument with reference to a number of recent Australian health promotion campaigns, including ‘Condoms Every Time’ and ‘Negotiated Safety’ .

Community development, planning and partnerships have become important terms in health promotion but, up until now, debate around these concepts have been discussed more in planning science than in public health literature. Roar Amdam draws on theories and new empirical evidence from local, regional and international planning and public health in order to develop a new model for health promotion: empowerment planning. Much health promotion planning has focused on top-down approaches, and while efforts to be participative are made, it is often without having a clear understanding of how community empowerment can be accommodated within health promotion programs. Amdam's innovative concept combines top-down and bottom-up approaches to enable people to take more responsibility for their own health and for individual and collective capacity building. Planning in Health Promotion Work is suitable for all students and researchers of health promotion and health planning and development, whilst the numerous applied examples make it an invaluable resource for policymakers and practitioners working in public health.

BackgroundDisadvantaged groups are often not reached by mainstream health promotion interventions. Implementing health promotion (HP) interventions in social economy companies, can be an opportunity to reach those people. The implementation of these interventions in social economy companies was studied. Factors that could be related to the implementation of HP and being supportive towards implementation in the future, were investigated.MethodsAn online, quantitative survey was sent to all 148 sheltered and social workshops in Flanders. In the questionnaire, the status of HP interventions and characteristics of the workshop were explored. Personal factors (such as attitudes towards HP, behavioural control, social norms and moral responsibility) were asked to the person responsible for implementation of HP interventions. Univariate and multivariate logistic regressions were performed.ResultsRespondents of 88 workshops completed the questionnaire. Almost 60 % of the workshops implemented environmental or policy interventions. Having a positive attitude towards HP, being more morally responsible, and having the subjective norm that employees are positive towards health promotion at work, were related to being more supportive towards the implementation of HP in the univariate analyses. Only attitude stayed significantly related to being more supportive towards the implementation of HP in the multivariate analyses.ConclusionsSheltered and social workshops are open to HP interventions, but more can be done to optimize the implementation. To persuade persons responsible for the implementation of HP to invest more in HP, changing attitudes concerning the benefits of health promotion for the employee and the company, is an important strategy.