Men and health promotion in the UK: Ten years further on?

The field of men's health has grown markedly over the past few decades. Increased activity specifically relating to men's health promotion in both Australia and the UK has been noted during this period. There has, however, been a reticence to critically examine men's health promotion work within a broader discourse relating to gender and gender relations. Indeed, the vast majority of health-related gender discussion to date has been focused on women's health experiences and their health practices. In this paper, we argue that grounding men's health within this broad gender discourse is important for building an evidence base in, and advancing, men's health promotion work at a range of levels. We specifically explore the research, practice and policy contexts relating to men's health in Australia and the UK, and describe the facilitators for, and barriers to, promoting men's health. We conclude by suggesting that a critical gender lens ought to be applied to current men's health promotion work and provide strategies for researchers, practitioners and policy makers to move towards this new frontier.

Dans une perspective de promotion de la santé, qui vise à donner aux personnes la maîtrise de leur propre santé, la proposition théorique et méthodologique que nous présentons s’intéresse à comprendre comment les inégalités sociales basées sur le genre, l’ethnicité, le statut socioéconomique, etc. conditionnent la capacité des jeunes d’agir pour leur santé. Nous focalisant sur les jeunes (18-24 ans), nous mobilisons la notion de « capacités » d’Amartya Sen (1993) pour concevoir le rôle actif des individus par rapport à leur santé, ainsi qu’une approche intersectionnelle qui, au lieu d’analyser les inégalités sociales de façon isolée, met l’accent sur l’imbrication de celles-ci afin de mieux comprendre les mécanismes qui les produisent. Nos objectifs sont (a) cerner les différentes formes de capacité d’agir qu’on les jeunes pour leur santé prend et à (b) analyser comment cette capacité est conditionnée par les inégalités sociales afin d’ (c) identifier des pistes d’action pour améliorer l’ empowerment des jeunes. Notre démarche méthodologique s’appuie sur deux volets. Un premier volet, à visée exploratoire, utilisera la méthode d’analyse en groupe afin de réaliser un diagnostic de ressources et de contraintes des jeunes pour agir pour leur santé, ainsi que d’identifier les catégories sociales les plus pertinentes pour l’analyse intersectionnelle. Sur cette base, le deuxième volet, basé sur la technique des récits de vie, a pour objectif de saisir l’interaction des inégalités sociales telle qu’elle est vécue par les jeunes et d’analyser comment cette interaction façonne leur capacité d’agir de façon favorable à leur santé. Ainsi, nous décrivons une démarche méthodologique pour l’étude de la capacité d’agir pour la santé afin de proposer une nouvelle grille de lecture, empiriquement fondée, pour la conceptualisation des programmes en promotion de la santé.

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.

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.

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.

The clinical content of preconception care: preconception care for men

AimOwing to the COVID-19 pandemic, many companies shifted to telework, with few insights into its implementation, organisational conditions or the role of workplace health promotion and management. This study focused on a multifactorial investigation of conditions in companies which implemented and evaluated telework during the first lockdown in 2020 as well as on their future intentions to facilitate teleworking under health-promoting working conditions.Subject and methodsThe research hypotheses relate to an extended technology acceptance model. In a mixed-methods design, expert interviews were fed into the development of an online questionnaire. Out of 1858 contacted companies representing a broad range of Austrian businesses, 192 responses (general management, workplace health managers, etc.) were analysed using descriptive and multivariate statistics.ResultsThe degree of implementation and claim to teleworking increased significantly during the first lockdown and did not return to pre-pandemic levels afterwards. Changes depended on preparation and experience: evaluation of teleworking and willingness to continue offering teleworking were conditional on preparation and the degree of implementation. Prerequisites for future intentions to implement health-promoting teleworking included readiness, general willingness and existing workplace health promotion/management structures.ConclusionThis paper demonstrates the potential of health-promoting organisational cultures for development processes – particularly in times of crisis. Anchoring health-focused structures in companies helps to create health-promoting frameworks. Health-promoting teleworking can be developed from workplace health promotion/management using established approaches. It is essential to build on in-house capacities and competencies to develop awareness for a holistic culture for health-promoting (tele)work and to encourage deliberations about potential measures.

Occupational therapy practitioners are uniquely qualified and positioned to offer both preventive and rehabilitative models of care. However, the status quo of current reimbursement models has created a barrier to occupational therapy practitioners receiving adequate reimbursement, if any, for doing health promotion and lifestyle-focused work. In this Health Policy Perspectives article, we emphasize the need for reimbursement and propose pathways for new and perhaps untapped or underutilized models of reimbursement for occupational therapy practitioners. These pathways require education and advocacy efforts to showcase our distinct value as key reimbursable and interdisciplinary players in lifestyle medicine and health promotion work.

This article presents an interpretation of health promotion within the work of a district nurse (DN). Literature supports the centrality of health promotion within nursing. It also presents debate about its meaning and suggests uncertainties for educators and practitioners about its relationship to nursing care. Two studies in Scotland on community nurses' health promotion work with older people suggested that health promotion was evident and recognisable in planned initiatives or projects but could be hidden and unrecognised in day-to-day nursing work with individual patients and their families. An experienced DN's interpretation of health promotion embedded in her work with a patient with multiple sclerosis is presented. The case was one of a number derived from a study designed in the constructivist paradigm, which addressed health promotion in relation to community nurse education and practice for a range of community nursing roles, including district nursing. The case study data were derived from observation of practice, interviews with the DN and the patient and from field notes. Health promotion emerged as embedded within day-to-day holistic nursing care. The DN illustrated an understanding of the dimensions of health and of the significance of core health promotion concepts such as education, prevention, advocacy, empowerment, self-esteem and self-efficacy. However, health promotion could be invisible, described as weaved into everything and on the back of other things, and therefore not normally acknowledged and clearly articulated. Embeddedness highlighted the challenge for evaluation, when nursing and health promotion activities are intrinsically related and can be argued as sharing certain principles, processes and outcomes. Embeddedness is a significant issue for learning in practice. The ability of experienced community nurses to interpret and articulate the concept of health promotion clearly and to make tacit knowledge evident would be of benefit to students.

I always read with interest any nursing article that professes to deal with health promotion and this was no less so with Irvine’s recent article regarding ‘health promotion’ competencies as they relate to the discipline of district nursing. It is timely that more nursing-specific articles are addressing what they perceive to be health promotion issues – even if it is not actually health promotion that they are really addressing. Irvine’s article is no exception to the emerging tide of recent nursing-specific literature that is conceptually confused when it comes to health promotion activity. This is not a major problem, at this juncture, because such articles serve as a useful springboard to rectify the situation by allowing the real context and location of health promotion to surface through debate such as this. Where it becomes a problem, however, is if, in the face of the established position of health promotion in today’s context, nursing continues to disregard later perspectives in favour of ‘old-guard’ regimes and practices. I have been one of those who particularly seek to champion the real ‘new’ context of health promotion (which actually is not that new anymore) in the hope of moving things on for health-related activity in nursing (i.e. Whitehead 2001, 2003a,c, 2004, 2005). What Irvine (2005) refers to in her article as the ‘new paradigm’ of health promotion and her additional use of the term ‘traditional health promotion’ are very much out-of-date and outmoded concepts. She uses Maben and Macleod-Clark’s (1995) concept analysis as a basis for her interpretation of health promotion as it pertains to the study’s highlighted competencies. As we can already see this article is a decade old and has been both critiqued and superseded by a more recent concept analysis, that identifies current health promotion process in its much broader context of socio-political process, overall population health strategy and ‘whole’ community empowerment (Whitehead 2004). This type of activity is now inherent in the majority of mainstream health promotion literature – and what nursing should be striving to reflect in its health promotion activity. What Irvine (2005) is really referring to in her article is the notion of health education competencies as they relate to district nursing practice – not health promotion. There are different levels of health education practice and, admittedly, some of those highlighted in Irvine’s article do refer to less limiting health education techniques – namely those that acknowledge the contribution of individual empowerment, community presence and political awareness – what I would refer to as the ‘education’ component of health education practice (Whitehead 2004, Whitehead & Russell 2004). There is, however, a huge gap between community presence and ‘community empowerment’ and the same is true for the difference between political awareness and being ‘politically active’ – both, which are a mainstay of current health promotion activity. Irvine’s study mainly identifies the district nursing competencies of disease process, ill health, opportunism, lifestyle and behaviour-change, psychomotor, cognitive and affective activity and epidemiology – which are very much entrenched within conventional and traditional approaches to health education. Irvine has demonstrated just how easy it is for nursing to fall into the trap of contextually confusing our practices and failing to move forward from current locations. Downie et al. (1996, p. 12) have described this phenomenon stating that:

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 by primary care nurses in Australian general practice

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.

The research outlined in this paper aimed to establish a consensus view amongst primary healthcare professionals about the competencies that district nurses need in order to fulfil an effective role in health promotion. In recent years there has been a growing emphasis on health promotion in primary care in the United Kingdom and health promotion is becoming increasingly important to nurses who work in the community. However, consideration of the role of the district nurse in health promotion is rather restricted and consequently district nurses have limited access to empirical evidence, from which they can develop their work in health promotion. The Delphi technique was used for this study. Seventy-two primary healthcare professionals were mailed a series of three questionnaires, which achieved response rates of 86, 87.5 and 78.9%. There was a consensus amongst the panellists that district nurses require a range of competencies to engage effectively in health promotion. These were categorized to produce a definitive list of eight knowledge-, seven attitude- and eight skill-related competencies. For the first time, this study achieves a consensus on the competencies needed by district nurses to engage in health promotion. District nurses should feel encouraged to develop their health promotion role in light of the fact that many of the competencies that they require for this activity have been identified as essential for their day-to-day nursing practice. The research highlights the fact that new paradigm health promotion is a concept that has moved beyond the academic arena and is recognized as significant by practising health professionals.

Introduction: Health promotion is a complex interdisciplinary field and health promotion workforce capacity is influenced by the skills, knowledge and work practices of those doing health promotion work. Place based and settings based approaches to health promotion offer a framework for grounding the complexity of health promotion practice in context. This presentation reports on the baseline capacity of community based health promotion practitioners by exploring the nature and extent of their health promotion practice. This study is one part of an Australian Research Council linkage project, the overall aim of the project was to improve health promotion workforce capacity. Methods: Five focus groups were conducted with participants in roles including: Hospital based nurse practitioner; school based health nurse; community health home care; multidisciplinary community health; and dedicated health promotion practitioners. Results: Thematic analysis of the data illustrated tensions between health promotion roles, resources and capacity. Additionally there were contrasting disciplinary approaches to similar problems and contrasting understandings and use of evidence in practice. Practitioners from different sectors and roles approach health promotion in different ways, even in the context of existing collaborations. Health promotion practitioners have insight into opportunities for service improvement and integration. Conclusion: This research highlights that although contrasting philosophies underpin health promotion practice in the community there is an opportunity and a need to work with practitioners to find innovative ways to collaborate across sectors, and thus improve the translation of health promotion evidence into practice.