Health Promotion Professionals Research Articles

Experienced facilitators and challenges of practising motivational interaction: How can pre-service physical education teachers adopt more motivational behaviours?

Health promotion professionals can contribute to high-quality motivation and sustained health behaviours, for example, physical activity (PA), using motivational interaction with their target groups. However, evidence shows that even after comprehensive training, professionals do not optimally adopt motivational counselling styles. To improve efforts to help professionals take up and sustain motivational interaction in their practice, we need a better understanding of influences on practising these styles. This study set out to investigate pre-service physical education (PE) teachers' experienced facilitators and challenges of practising motivational interaction. After a training course that aimed to teach pre-service PE teachers the basic ideas and practical techniques of motivational interaction, 19 participants were interviewed. Inductive content analysis was employed to investigate semi-structured interviews. We developed three categories each including both facilitators and challenges of practising motivational interaction: (1) own style of interaction functioned as a basis for practising and involved (a) confidence in skills and resources as well as (b) reflecting, overcoming and forming habits, (2) regulation of one's own behaviour: autonomy and responsibility involved the freedom to choose and plan how to practise but also bearing responsibility for it, and (3) pursuing authentic interaction related to the search for natural ways to use motivational interaction with others. We provide suggestions on how future training can make use of this knowledge and systematically make use of behaviour change science to foster practising motivational interaction, for example, using self-regulation strategies and habit-forming/breaking skills.

Qualitative multi-stakeholder evaluation of the adoption, implementation and sustainment of theschool-based dietary intervention "Jump-in".

Comprehensive school-based programs applying the WHO Health Promoting School Model have the potential to initiate and sustain behavior change and impact health. However, since they often include intervention efforts on a school's policies, physical environment, curriculum, health care and involving parents and communities, they significantly 'intrude' on a complex system that is aimed primarily at education, not health promotion. More insights into and concrete strategies are therefore needed regarding their adoption, implementation, and sustainment processes to address the challenge to sustainable implementation of HPS initiatives in a primarily educational setting. This study consequently evaluates adoption, implementation and sustainment processes of Amsterdam's Jump-in healthy nutrition HPS intervention from a multi-stakeholder perspective. We conducted semi-structured interviews and focus groups with all involved stakeholders (n = 131), i.e., Jump-in health promotion professionals (n = 5), school principals (n = 7), at-school Jump-in coordinators (n = 7), teachers (n = 20), parents (n = 50, 9 groups) and children (n = 42, 7 groups) from 10 primary schools that enrolled in Jump-in in the school year 2016-2017. Included schools had a higher prevalence of overweight and/or obesity than the Dutch average and they were all located in Amsterdam's low-SEP neighborhoods. Data were analyzed using a directed content analysis, in which the Determinants of Innovation Model was used for obtaining theory-based predetermined codes, supplemented with new codes emerging from the data. During intervention adoption, all stakeholders emphasized the importance of parental support, and accompanying workshops and promotional materials. Additionally, parents and teachers indicated that a shared responsibility for children's health and nuanced framing of health messages were important. During implementation, all stakeholders needed clear guidelines and support structures. Teachers and children highlighted the importance of peer influence, social norms, and uniform application of guidelines. School staff also found further tailoring of the intervention and dealing with financial constraints important. For long-term intervention sustainment, incorporating the intervention policies into the school statutes was crucial according to health promotion professionals. This qualitative evaluation provides valuable insights into factors influencing the adoption, implementation, and sustainment processes of dietary interventions, such as the importance of transparent and consistent intervention guidelines, clear communication regarding the rationale behind intervention guidelines, and, stakeholders' involvement in decision-making.

Comparative Health Behaviour of Young People with Disabilities in Hungary: A Cross-Sectional Study.

The health status of Hungary's population is unfavorable, with significant differences in health indicators not only compared to the EU15 but also to the Visegrad countries. Unfavorable health indicators can be disproportionate and particularly affect vulnerable groups, such as people with disabilities. In this study, we set out to compare the health behavior of disabled youth and youth with typical development in Hungary. We also aimed to compare the health behavior of adolescents in the Visegrad countries. The eating habits of both groups of young people we examined are unfavorable. Adolescents with disabilities experience a significantly higher rate of school stress than children with typical development in Hungary. The prevalence of somatic complaints and parameters of poor mental well-being are significantly higher in Hungary than in the other Visegrad countries. The results indicate that additional interventions are needed in Hungary and that differentiated, professional health promotion is needed for young people with disabilities. The researchers recommend extending the study to disabled adolescents living in Visegrad countries, on the basis of which an injury-specific health promotion methodology could be developed with international interprofessional cooperation.

Factors influencing breast cancer screening practices among women worldwide: a systematic review of observational and qualitative studies

BackgroundThe variation in breast cancer incidence rates across different regions may reflect disparities in breast cancer screening (BCS) practices. Understanding the factors associated with these screening behaviors is crucial for identifying modifiable elements amenable to intervention. This systematic review aims to identify common factors influencing BCS behaviors among women globally.MethodsRelevant papers were sourced from PubMed, Scopus, Embase, and Google Scholar. The included studies were published in English in peer-reviewed journals from January 2000 to March 2023 and investigated factors associated with BCS behaviors.ResultsFrom an initial pool of 625 articles, 34 studies (comprising 29 observational and 5 qualitative studies) with 36,043 participants were included. Factors influencing BCS behaviors were categorized into nine groups: socio-demographic factors, health status history, knowledge, perceptions, cultural factors, cues to action, motivation, self-efficacy, and social support. The quality appraisal scores of the studies ranged from average to high.ConclusionsThis systematic review highlights factors pivotal for policy-making at various levels of breast cancer prevention and assists health promotion professionals in designing more effective interventions to enhance BCS practices among women.

Virtual Workshops as an Effective and Engaging Policy Implementation Strategy: Lessons From the National Youth Sports Strategy.

Implementation is an important piece of effective policymaking, but connecting local organizations with federal policy can be challenging. A virtual workshop structure can help engage implementation partners, especially when in-person events are not possible. The workshops described here leveraged virtual outreach and facilitation methods to foster community engagement, forge connections, and build relationships at the regional, state, and local levels. This article focuses on five virtual workshops. The planning phase consisted of selecting the geographic scope of each workshop, developing outreach and facilitation materials, and supporting event logistics. The execution and summary phase included tailoring materials, hosting the events, and producing follow-up materials. Networking, resource sharing, collaboration, and active facilitation were employed to promote engagement. Registration for the virtual workshops included 223 individuals representing organizations in 28 states. Participants shared 133 resources. In a post-event evaluation, 93% of respondents indicated they could identify at least one new resource to support their efforts to increase youth sports participation in their community, and 94% indicated they plan to follow up and explore potential partnerships/collaborations with others they met or heard from at the workshop. Networking and resource sharing were identified as the most useful aspects of the workshops. With careful planning and collaboration, virtual workshops represent a useful community engagement mechanism to bring policy into practice. Creating events focused on the participant experience supports health promotion professionals, engages communities, and takes a policy off the page and out to the people.

Criteria for best practice in health promotion

Abstract There are many interventions that take a health-promoting approach. But are they really good and do their implementation lead to results that are also a sustainable improvement for the target group in a setting? Can this improvement be scientifically evaluated and even measured or is it based on a well-intentioned perception only? The criteria for good practice from Germany, which were developed in 2003 by the Advisory Working Group of the nationwide Collaborative Network for Equity in Health of BZgA, aim in particular for professionals in community health promotion to reflect on their work and to support them in further developing and strengthening the quality of their health promotion services. The (twelve) good practice criteria, in practical language and in the form of twelve fact sheets, each contain a definition, implementation stages of the criterion, their explanation (illustrated with examples from practice) as well as further literature. The good practice criteria include conception and target group reference and take into account participation and empowerment, but also sustainability and cost-effectiveness. These criteria also serve as selection criteria for interventions to be included in the German Good Practice Portal which has a particular focus on tackling health inequalities. In a brief presentation these criteria will be presented to the participants of the workshop in order to subsequently discuss and exchange approaches from other countries.

Refining Multilevel Barrier and Facilitator Measures for HIV Testing and PrEP Among Latino Sexual Minority Men.

The purpose of this study is to refine and establish measures of multilevel barriers and facilitators to HIV testing and PrEP for Latino sexual minority men (LSMM). Cross-sectional measure validation. Participants from Miami, FL. 290 LSMM from the DÍMELO study. Based on prior qualitative work, we developed two measures that evaluated multiple determinants (i.e., barriers and facilitators) to (1) HIV testing and (2) PrEP use. All measures included in this analysis assessed a set of theoretically distinct barriers and facilitators. We performed 11 exploratory factor analyses (EFA) to assess the dimensionality of theoretical groupings of items informed by prior qualitative work, including: knowledge, perceived need and benefit, mistrust and concerns, stigma and normalization, cultural competence, navigation support, provider demeanor, clinic and medical system issues, privacy concerns, cost, and language and immigration barriers. Based on EFA results, we conducted two confirmatory factor analyses (CFA), one for each measure. Within each measure, the 11 EFAs extracted 10 barrier factors and 7 facilitator factors. The CFAs for HIV testing and PrEP measures were consistent, such that all models retained the structures identified in the EFAs. Findings support the use of these measures with LSMM. These measures can inform multilevel implementation strategies for health promotion professionals to scale up and disseminate HIV prevention services to LSMM.

The Effects of the Jump-In Whole-School Intervention on the Weight Development of Children in Amsterdam, the Netherlands.

This study assessed the effects of the "Jump-in" whole-school intervention in Amsterdam, the Netherlands, on children's weight development by comparing children exposed to the intervention and controls from 3 other large Dutch cities. Jump-in is a comprehensive intervention that aims to stimulate healthy nutrition and physical activity in children at primary schools in Amsterdam. In addition, the relationship between the intervention's implementation degree and its effectiveness was studied. Demographic and anthropometric data, collected by youth health care professionals via routine health checks at T0 (2014) and T1 (2019), were used to analyze possible intervention effects by comparing the weight development of children exposed to the Jump-in intervention versus unexposed controls. Implementation logs from health promotion professionals were used to determine intervention effects per implementation degree. Multilevel regression analyses were used for all analyses. In total, 4299 children were included mean age ± 5.5 years (T0), 10.6 years (T1), and ≈50% boys/girls at both times. Receiving the fully implemented intervention resulted in a decline in standardized body-mass index (zBMI) compared to the controls (-0.23, confidence interval [CI] -0.33, -0.13). It also led to higher odds to move into a healthier weight category over time (odds ratio [OR] 1.36, CI 1.06, 1.74), yet no statistically significant shift towards a healthy weight was found. Relative to the controls, children exposed to the intervention showed positive zBMI developments, with stronger effects when the implementation degree was higher. Despite positive results, creating more impact might require the further integration of school-based programs into whole-systems approaches that include other energy-balance behaviors.

Service Learning in Public Health: A Critical Assessment of Potential Benefits and Unintended Consequences

Service learning is a pedagogical strategy in which students complete a project at a community-based organization where they can apply classroom skills in a real-world context. Service learning can benefit student learning outcomes and continues to expand in public health education; yet there is the potential for ethical concerns. In particular, service learning may reinforce inequities between academic institutions and community organizations by positioning academic institutions as holding significant power and resources and inadvertently promoting this dynamic to students. This perspective provides an overview of service learning in public health and related fields, discusses the benefits of service learning as well as the gaps in standardization and evaluation, and highlights situations in which inequities may emerge. Recommendations are provided, with the goal of helping future health promotion professionals better meet the objective of fostering social justice through public health.

The Weight Stigma Heat Map: A tool to identify weight stigma in public health and health promotion materials.

Public health campaigns and health promotion endeavours have been criticised for perpetuating weight stigma by reinforcing misinformation and using deficits-based narratives about larger-bodied people. The aim of this project was to develop a 'heat map' tool to appraise existing health policy and resources for elements that promote weight stigma. Ten themes were identified from literature using inductive analytic review methodology including pictorial/photographic representation, weight-health beliefs, body weight modifiability and financial concerns. Each theme was divided into four appraisal categories: the demonstration of weight stigma (via negative stereotyping, prejudice or discrimination that limits access to opportunities or services), weight bias (via presenting smaller bodies as normal/natural/healthy/good/desirable), bias-neutral (via representation of people of all shapes and sizes and accurate and nuanced health information about larger-bodied and smaller-bodied people) and finally an anti-stigma approach (via use of strengths-based narratives and overtly positive representation of and leadership by larger-bodied people). A colour coding schema (the 'heat map') to visualise stigmatising elements across materials and a scoring system was devised for future quantitative evaluation. To demonstrate the use of the Weight Stigma Heat Map (WSHM), the Australian National Obesity Strategy 2022-2032 was appraised. It is likely that weight stigmatisation is an important but under-recognised factor influencing the effectiveness of campaigns and interventions promoting behaviour change. SO WHAT?: Public health and health promotion professionals should consider using the WSHM as a framework for the development of less stigmatising policies, campaigns and resources and to direct reviews of existing materials.

The Relationship between Physical Activity and Life Satisfaction among Omani Teachers

Teachers' health habits can have an impact on their students. Despite this, few studies have been conducted to investigate teacher physical activity and its relationship to life satisfaction. The prevalence of obesity has steadily increased over the years. Among both genders, the age-adjusted prevalence of being overweight or obese is higher among Omani participants across time. This study looks into how physical activity relates to life satisfaction among Oman's teachers. Some 671 teachers (40.3% male; 59.7% female) aged 20-50 years took part in the survey. Participants were recruited using a Google form survey. SPSS statistical tools were used to analyse the collected data. According to the findings, Physical Activity has a significant positive correlation with life satisfaction. The findings also revealed that gender influenced Omani teacher life satisfaction, with female teachers having higher life satisfaction than males. This study found no significant differences in life satisfaction based on age or Body Mass Index (BMI). This study was intended for use in public schools. More research can be conducted in both private and public schools. In sum, health promotion professionals might develop plans to improve employee health status if they had a better grasp of impact of factors associated with physical activity participation. As a result, there will be improvement in worker life satisfaction, which is considered to be a cognitive component of subjective well-being.

PRÁTICAS DE PROMOÇÃO DA SAÚDE NA ATENÇÃO PRIMÁRIA: COMPARATIVO ENTRE FLORIANÓPOLIS-BRASIL E GIRONA-ESPANHA

ABSTRACT Objective: to understand the health promotion practices developed by nurses in the Primary Care context in Florianópolis and Girona. Method: this is a comparative study with a qualitative approach and of the descriptive exploratory type, carried out with eight nurses between June 2021 and April 2022 in health units that developed health promotion practices. The data, collected by means of semi-structured interviews, were analyzed through thematic analysis based on the health promotion framework. Results: four categories related to health promotion practices emerged from the data, namely: Training actions for health professionals in health promotion; Health promotion activities in individual consultations; Health education group activities; and Community health promotion actions. Conclusion: it is concluded that, in both municipalities, nurses develop individual and collective health promotion practices through groups and community actions, focusing on lifestyle changes. In Florianópolis they are grounded on the National Health Promotion Policy and, in Girona, health promotion actions are based on actions involving specific groups aimed at preventing diseases.

Development of a health-promoting sports club's intervention in France applying participatory action research.

The recognition of sports clubs (SC) as health-promoting settings is increasing, as well as the number of health promotion (HP) interventions implemented in this setting. However, minimal understanding of their development process and the persistent gap between theoretical knowledge and real-life practice is a major limitation to their implementation. This article describes a participatory research approach, implicating 29 stakeholders in sports and HP (6 HP researchers, 9 HP professionals, 6 representatives from regional and national sports organizations and 8 representatives from SC), leading to the co-construction of a health-promoting SC intervention. Stakeholders were mobilized through four stages: (i) analysis of effective programs, (ii) co-construction workshops, (iii) evaluation of relevance and acceptability, and (iv) beta-testing of a massive open online course (MOOC). A qualitative analysis was carried out on data collected through notetaking, recordings, transcripts, email exchanges and produced documents. This work led to the development of an HP intervention, including an MOOC, as well as a seven-step SC-tailored program. The convergence of theoretical knowledge and contextual real-life practice made it possible to respond to the specific needs and implementation problems encountered by SC actors and to develop acceptable strategies and tools.

Quality of life and associated factors among the youth with substance use in Northwest Ethiopia: Using structural equation modeling.

Substance use leads to serious clinical conditions with the potential to cause major health and emotional impairments in individuals. Individuals with substance use typically report significantly poorer QoL than the general population and as low as those with other serious psychiatric disorders. It has a high impact on morbidity, mortality, and productivity, it also compromises the general safety and performance of the users, i.e., affects the quality of life. Therefore, this study aimed to assess quality of life and identify the potential predictors among youths who use substances. A multicenter cross-sectional study design was applied to assess quality of life and associated factors among substance use youths in the central Gondar zone from January 1 to March 30/ 2021. A total of 373 substance use youths were included in the study. The data were collected using face-to-face interview by structured questionnaires, and entered to Epi-data version 4.6 and exported to STATA version 16, and AMOS software for further statistical analysis. To identify factors associated with health-related quality of life, structural equation modeling was used, and it also used to estimate the relationships among exogenous, mediating, and endogenous variables. Substance used youths had a moderate overall health-related quality of life (mean score = 50.21 and 14.32 standard deviation, p-value < 0.,0001), and poor health-related quality of life in the environmental health domain (mean score of 45.76 with standard deviation of 17.60). Age (β = 0.06, p<0.001), sex (β = 0.30, p<0.001), psychotic symptoms (β = -0.12, p<0.001), employment status (β = 0.06, p = 0.008,), loss of family (β = 0.35, p<0.001), and social support (β = 0.27, p<0.001) were variables significantly associated with health-related quality of life. According to the findings of this study, substance abuse during adolescence is associated with lower health-related quality of life and a higher report of psychopathological symptoms. Given this finding, mental health and health promotion professionals should learn about and emphasize the impact of substance use on youth quality of life.

Reciprocal effects of esport participation and mental fatigue among Chinese undergraduate students using dynamic structural equation modeling

Esport has emerged as a global phenomenon in recent years, particularly among college students, but limited studies have examined its relationship with mental fatigue. This study aimed to examine the relationship between esport participation and mental fatigue among Chinese undergraduate students. Data from 63 college students who completed a 15-day survey were analyzed using bivariate dynamic structural equation modeling. Results showed that 80.95% of students who played more esport also experienced more mental fatigue immediately after gameplay. In addition, 25.40% of students who experienced increased mental fatigue immediately after gameplay reduced their subsequent esport participation time 12 h later. In general, students who participated in esport for longer were more likely to experience higher mental fatigue, lingering feelings of mental fatigue, and to reduce their subsequent esport participation time as a result of previously increased after-game mental fatigue. Our findings suggest that participating in more esport not only leads to increased mental fatigue immediately following gameplay, but that a sustained high level of esport participation is also associated with a consistent high level of mental fatigue and a lingering feeling of mental fatigue. Health promotion professionals and policymakers should explore measures that might be implemented to promote healthier esport behaviors among college students.

Health Promotion and Education: Foundations for Changing Health Behavior

The ongoing COVID-19 pandemic has reemphasized the criticality of human behaviors and led to an enormous focus on health promotion and risk communication messaging; ‘COVID appropriate behavior’ is indeed a household term now. Dedicated or specialist health promotion professionals and scholars are few and far between and the author, Professor Madhumita Dobe, is both a pioneer and icon to generations of public health students and researchers. She has authored this book, filling up a much-needed void in this discipline. As she has acknowledged, this book is the culmination of a lifetime of teaching, research and practice at the All India Institute of Hygiene and Public Health, Kolkata and her rich experience across the states of India and several countries.

"We'd be really motivated to do something about it": A qualitative study of parent and clinician attitudes towards predicting childhood obesity in practice.

In Australia, one in four (24.9%) children live with overweight or obesity (OW/OB). Identifying infants at risk of developing childhood OW/OB is a potential preventive pathway, but its acceptability is yet to be investigated in Australia. This study aimed to (1) investigate the acceptability of predicting childhood OW/OB with parents of infants (aged 0-2 years) and clinicians and (2) explore key language to address stigma and maximise the acceptability of predicting childhood OW/OB in practice. This was a cross-sectional and qualitative design, comprising individual semi-structured interviews. Participants were multidisciplinary paediatric clinicians (n=18) and parents (n=13) recruited across public hospitals and health services in Queensland, Australia. Data were analysed under the Framework Method using an inductive, thematic approach. Five main themes were identified: (1) Optimism for prevention and childhood obesity prediction, (2) parent dedication to child's health, (3) adverse parent response to risk for childhood obesity, (4) language and phrasing for discussing weight and risk and (5) clinical delivery. Most participants were supportive of using a childhood OW/OB prediction tool in practice. Parents expressed dedication to their child's health that superseded potential feelings of judgement or blame. When discussing weight in a clinical setting, the use of sensitive (ie, "overweight", "above average", "growth" versus "obesity") and positive, health-focused language was mostly supported. Multidisciplinary paediatric clinicians and parents generally accept the concept of predicting childhood OW/OB in practice in Queensland, Australia. SO WHAT?: Clinicians, public health and health promotion professionals and policymakers can act now to implement sensitive communication strategies concerning weight and obesity risk.

Alleviating work-family conflict for female employees in Iran: The effect of a multimedia educational intervention.

Work-family conflict can lead to irreparable losses to individuals, families and organizations. This matter is especially important for married working women who cannot eschew home responsibilities. To consider an appropriate intervention for this issue, we investigated the effect of a one-month intervention on support from the workplace and the family, individual characteristics and work-family conflict. This quasi-experimental longitudinal study includes an intervention group and a control group, and uses a pre-test, post-test and 6-months follow up design. Participants were 120 married women working in healthcare services, recruited from two cities in South Iran. The web-based multimedia educational program comprised four modules: one for each of the women participants, their spouses, their co-workers, and their workplace supervisors. Data collection tools included a demographic information form, and co-worker support, supervisor social support, spouse support, core self-evaluation and work-family conflict questionnaires. The effect of the intervention was examined at two post-intervention time points. A comparison of changes in mean scores between the intervention and control groups indicated that scores of supervisor support, spouse support, core self-evaluation and work-family conflict in the intervention group one month and six months after the intervention were all significantly improved compared to before the intervention. There was no benefit of the intervention in terms of a change in co-worker support. There was no significant difference across the three time points in the control group. These results confirm that online educational methods can enable health promotion professionals to reduce work-family conflict to the benefit of both employees and organizations.

Attitudes and perceptions of Nigerians regarding receiving COVID-19 vaccines: an online cross-sectional study

Introductionthe success of controlling pandemics like COVID-19 can be achieved through its vaccination program. Besides masks, social distance, and good hand hygiene, a rapid vaccine program is crucial in controlling this COVID-19 pandemic. Thus, this study aimed to assess the attitudes and perceptions of Nigerians regarding accepting the COVID-19 vaccine.Methodsa cross-sectional study was carried out among 334 respondents aged 18 and above from the Southeastern region of Nigeria. A validated questionnaire was used for the data collection through an online Google form. The data analysis was done using SPSS version 25. The association of socio-demographics with attitudes and perceptions was analysed using chi-square tests and Fisher exact tests. At the 95 percent confidence level, a p-value of 0.05 was deemed statistically significant.Resultssixty point two percent (60.2%) (n = 201) of respondents showed positive attitudes with a mean of (13.96±2.97). Gender was the only demographic factor associated with attitudes (p< 0.001). Respondents with poor perceptions were higher by 53.0% (n = 177) with a mean value of (3.30±1.17). Age, education, gender, and marital status were seen to be associated with perceptions of vaccine acceptance (p<0.05). There was a link between attitudes and perceptions (P> 0.001), as those with positive attitudes also exercised good perceptions.Conclusionthis study revealed that respondents had positive attitudes regarding COVID-19 vaccination acceptance but negative perceptions of it. As a result, community and health promotion professionals, religious leaders, and local celebrities should use their platforms to raise awareness about the benefits of COVID-19 immunization.

Health Promotion Capacity Among Chinese Healthcare Professionals and Its Influence on Preventive Health Service Practices.

BackgroundThis study evaluated the current health promotion capacity level of Chinese healthcare professionals and explored the association between health promotion capacity and preventive health service practices.MethodsA total of 124 doctors and 72 nurses were recruited from 6 county hospitals and 12 community health centers from June to August 2019 in Zhejiang Province, China. Health promotion capacity was measured using the revised Chinese version of the Health Promotion Professionals Core Competency Scale.ResultsThe mean total score on the health promotion capacity scale was 45.04 (SD = 7.30). Total health promotion capacity score was negatively associated with county hospitals (β = −0.32, p < 0.001; Ref: community health center) and positively associated with a monthly income of more than 5001 RMB ($786.39) (β = 0.25, p = 0.004; Ref: less than 5000 RMB ($786.24)). All domain scores of the health promotion capacity scale were positively related to preventive health service practices.ConclusionHealth promotion capacity is one of the most important capacities among healthcare professionals, and there is a particular need to improve nurses’ capacity. A higher level of health promotion capacity is beneficial for implementing preventive health services.