Health Promotion Staff Research Articles

Let’s Get Walking: Establishing Workplace Walking Groups in a regional Public Health Department

Abstract Maintaining staff health and wellbeing (HWB) is an ongoing priority for the Department of Public Health HSE Dublin and Midlands (PHD). This is particularly important in the context of an ongoing programme of reform for Public Health in Ireland. To support this priority, in November 2023 a pilot Workplace Walking Groups initiative was established to increase workplace physical activity and build team relationships. The initiative was designed following staff feedback on team HWB initiatives in September 2023. The Model for Improvement (which includes the Plan-Do-Study-Act cycle) was used to take a structured quality improvement approach to the development and evaluation of the 4-week pilot, led by the PHD HWB Committee. Staff joined across 3 sites. Lunchtime walks were arranged for 1-2 days per week. WhatsApp groups and email supported group communication. Quantitative data on registration and attendance were collected via Microsoft Excel. A virtual focus group was arranged to gather participant feedback, which was analysed into themes. Group registration (n = 10, n = 9, n = 5) and weekly attendance varied by site (n = 10, n = 9, n = 5). Key benefits noted by participants included physical activity, building relationships with colleagues, and getting fresh air. The main barrier was the impact of work schedules on attendance. There was broad support for re-establishment of Workplace Walking Groups for 2024. This pilot Workplace Walking Groups initiative achieved its dual aim of increasing physical activity and social connection among staff. Learning from this pilot informed the launch of a 3-month Walking Groups term for Spring 2024. The initiative is now established practice and is a component of the Department’s blended working policy, being a feature of on-site working days. Key messages • Our successful pilot Workplace Walking Groups project has translated into a sustainable health and well-being initiative for staff, during a time of ongoing reform across Public Health in Ireland. • A structured approach to designing and implementing staff health promotion initiatives is crucial to support the cycle of learning and improvement, and to sustain change over time.

Management of Implementing Clean and Healthy Living Behaviorin Households in Manisa Village

The current policy that regulates clean and healthy living behavior is the Republic of Indonesia Minister of Health Regulation Number 2269/Menkes/Per/XI/2011 concerning guidelines for fostering clean and healthy living behavior. Clean and healthy living behavior is a government priority program through community health centers and is an output target in implementing health development. The lowest coverage of healthy households in the Manisa Health Center Working Area is in the existing Manisa Village. The aim of the research is to determine the management of implementing clean and healthy living behavior in the household setting. This type of research is qualitative research. The informants for this research, managers of the community health center's clean and healthy living behavior program, community health center leaders, cadres, community leaders, religious leaders and the public, were taken using purposive sampling. Data collection was carried out through in-depth interviews, documentation review and Focus Group Discussions. The results of the research showed problems with the input component, the health promotion staff at the community health center had never received training, the funding allocation was very small, and the supporting facilities for Promkes were limited to print media. In the process, planning has not been implemented in an integrated manner, the organization and implementation of health promotions has not been carried out optimally, and monitoring is only based on the results of surveys of household clean and healthy living behavior. It is known that the output component of implementing clean and healthy living behavior in household management is still below the target. Implementation of management of clean and healthy living behavior in household arrangements is not as expected. Therefore, it is necessary to improve the quality of implementing staff, allocate funds and infrastructure, as well as improve management in implementing clean and healthy living behavior in the household structure.

Faktor yang Berhubungan dengan Status Gizi Anak Balita di Wilayah Kerja Puskesmas Atambua Selatan Kabupaten Belu

Nutritional problem in toddlers are still a public helath problem in the South Atambua sub-district, Belu district. The purpose of this study was to analyze factors related to children under five in the working area of the Atambua Selatan Helath Center, Belu Regency. The population in this study were all mothers with toddlers aged 12-59 montsh, totaling 2.126 toddlers. The sample consisted of 219 mothers with random sampling. Data analysis was performed by univariate analysis and bivariate analysis by Chi-Square test. This type of research is aquantitative study using a cross sectional design. study uses a type of quantitative research with a cross-sectional study design with random sampling techiniques. Respondents in this study were mothers of toddlers, totaling 219 people. The study used univariate and bivariate analysis with the Chi Square test. The results of this study indicate that the variables related to nutritional status are knowledge (0,000), occupation (0,001), education (0,000) and food consumption (0,000). While the variable that is not related to nutritional status is income (0,721). Mother’s nutritional knowledge, mother’s occupation, mother’s education and food consumption have a significant relationship, while family income has no significant relationship with nutritional status. Community Healtg Centers are expected to be able to maximize counseling and counseling activities on a regular basis regarding toddler nutrition and the use of helath promotion media. As well as, the activie role of health workers is urgently needed, especially nutrition and health promotion staff to increase education efforts on the importance of nutritious food for toddlers.

10.K. Workshop: School health during the COVID-19 Pandemic. Perspectives from the COVID-HL school principal study

Abstract The COVID-19 pandemic is associated with far-reaching challenges for the educational system, which impact the health of all involved in the school context, making it a critical public health topic. Consequences include school-closures, a switch from face-to-face classroom learning to homeschooling via online learning, resulting in uncertainty, stress and an increased risk of reinforcing already existing inequalities. Since the pandemic started, some research has been conducted in child and adolescent populations. However, there is very limited research available exploring the effects of the pandemic on school principals, who are responsible for all aspects of the school life and therefore have to cope with particularly high demands as a result of the COVID-19 pandemic. Pre-pandemic research shows that school principals report high work-related stress and more frequently psychological and physical burden compared to other professional groups (Dadaczynski et al., 2020; Phillips et al., 2008). Moreover, little attention has been paid to what health promotion activities are implemented by schools during pandemic times and what the schools’ needs are in this area. To provide empirical evidence on that matter, a school principal survey was conducted within the international COVID-Health Literacy Research Network (www.covid-hl.org), that aimed to assess (1) work-related stress and strain, (2) corona-specific health literacy among school principals and (3) the implementation status of activities in school health promotion during the COVID-19 pandemic. This workshop aims to present and discuss findings of the COVID-HL school principal study from Germany, Italy, Poland, Switzerland and Wales, which have used the same instrument and study design. The first presentation will focus on the pandemic as a potential disruptive event impeding the implementation of holistic activities on school health promotion and prevention. In their presentation, Chiara et al. analyse beliefs about vaccines among principals and its associations with COVID-19 information satisfaction. The third presentation originates from Poland and will introduce findings regarding work-related coping behavior and its association with mental health of school principals. While the fourth presentation from Switzerland focus on the relationship between health literacy and health promoting activities implemented by schools, Marchant et al. explores the effects of the COVID-19 pandemic on senior leaders experiencing high job demands. Each project will be given ten minutes to present their findings, including questions, which will be followed by Q&A and an open discussion with the audiences. This workshop offers a forum for researchers, practitioners and policy-makers interested in school health promotion and school staff health. By dialogue and two-way communication, vivid interaction will be ensured, allow building synergies, and facilitate networking and capacity building. Key messages • School leaders should be systematically supported as ‘gate-keepers’ of school health promotion. • School principals represent a largely neglected target group for school health promotion.

The Potential for Total Worker Health® Approaches in State and Territorial Health Departments : A National Mixed-Methods Study.

To document the extent to which state and territorial health departments (SHDs) integrate their occupational safety and health (OSH) and workplace health promotion (WHP) activities consistent with a Total Worker Health (TWH) approach. Nationally representative survey of OSH and WHP practitioners at 56 SHDs followed by in-depth interviews. Despite reporting limited awareness of the TWH initiative and TWH resources, most respondents (57% OSH, 64% WHP) reported collaboration between OSH and WHP staff in their departments. Collaborations were described in-depth. Barriers to OSH-WHP collaborations included resource insufficiencies, organizational structure in the SHD, and conflicting practices. Facilitators included knowledge of TWH approaches, proximity to TWH Centers of Excellence, proximity between OSH/WHP programs, and leadership initiative. Motivations for collaboration were enumerated. Strategies for building TWH capacity and activity among SHDs are discussed.

Relationships between footedness and aging on postural control: Evidence from the Yakumo study

ABSTRACT The effects of footedness and aging on postural maintenance function were examined in this study. Using the postural maintenance task, the trajectories of the centre of pressure (COP) were measured with a stabilometer in the lateral and posterior/anterior directions. One hundred and ninety-three right-footers (112 middle-aged: 40–64 years old and 81 old-aged: 65–80 years old) and thirty-two left-footers (14 middle-aged and 18 old-aged) among healthy community members participated in this study. Using the ratio of the COP deviation area sizes for the open- vs. closed-eye conditions as an index, the ratios in the lateral and the posterior/anterior directions were compared in relation to the footedness and the age groups. The results indicated that the left-footers of the older adults group showed a larger COP deviation ratio than that of the middle-aged group, and the left-footers showed a larger deviation ratio in the lateral direction than in the posterior-anterior direction. These findings suggest a weak postural maintenance function of the older adults left footers. As most left-footers are left-handed, health promotion staff should notice that older adults who are left-handers are at a higher risk of falling.

Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial.

BackgroundFew translational trials have provided detailed reports of process evaluation results.ObjectiveThis study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children.MethodsMixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P<.05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively.ResultsData were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study; however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention; however, more participants actively withdrew from the telephone intervention.ConclusionsThis is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes.

Vision, future, cycle and effect: A community life course approach to prevent prenatal alcohol exposure in central Australia.

Issue addressedPrevention approaches specific to prenatal alcohol exposure (PAE) and foetal alcohol spectrum disorder (FASD) have been identified as urgently needed in Australia, including in Aboriginal and Torres Strait Islander communities. However, very little work has aimed to describe and evaluate health promotion initiatives, especially those developed in rural and remote areas.MethodsA series of television commercial scripts (scripts) were developed with health promotion staff at an aboriginal and Torres Strait Islander Community Controlled Health Service and piloted with 35 community members across six yarning sessions.ResultsScripts evoked responses in line with two predominant themes: “Strength” and “Community resonance.” This process led to the development of a four‐part television and radio campaign focusing on a life course approach to prevent prenatal alcohol exposure (PAE) – “Vision,” “Future,” “Cycle” and “Effect.”ConclusionsIntergenerational influences on PAE were key elements of scripts positively received by community members. Strengths of this work included a flexible approach to development, local aboriginal men and women coordinating the yarning sessions, and the use of local actors and familiar settings.So what?Preventing PAE is extraordinarily complex. Initiatives that are culturally responsive and focus on collective responsibility and community action may be crucial to shifting prominent alcohol norms. Future work is necessary to determine the impact of this campaign.

Organizational structure and human agency within the South African health system: a qualitative case study of health promotion.

Despite international recognition of health promotion (HP) as a cost-effective way to improve population health, it is not highly regarded nor is it sufficiently institutionalized in many health systems. This diminishes its ability to deliver on its public health promises. This paper examined the role of organizational structure and human agency within the South African health system (drawing on Giddens’s structuration theory) in determining the extent of, and barriers to, the institutionalization of HP. We conducted a qualitative case study using a combination of in-depth interviews (n = 37), key informant interviews (n = 8) and one-day workshops (n = 5) with Department of Health (DoH) staff (HP and non-HP personnel) from national, provincial and district levels as well as external HP stakeholders. Within the South African health system, there are dedicated HP staffs, with no specified professional competencies or a coherent hierarchy of job titles. Allocated HP resources were frequently shifted to other programmes. This resulted in a disconnect between national and provincial levels, which impeded communication and opportunity to develop a shared vision and coherent programme. We found some examples of successful HP organization and implementation practices, such as the tobacco control legislation. Overall, HP staff had limited agency and were often unable to articulate the vision for HP. Uncertainty about the role of HP has led to powerlessness, and feelings of resentment have generated demotivation and moral distress. HP voices were seldom heard and were repressed by dominant curative-focused structures. If leaders of HP continue to be embedded in such an institution, there is little chance of driving an effective HP agenda. Therefore, there is a need to engage policy-makers to integrate HP into the health system fabric. Establishment of an independent HP foundation could be one mechanism to drive multi-sectoral collaboration, contribute to evidence-based HP research and further develop health in all policies through advocacy.

Relationships between Urination Dysfunction (UD) and Brain Functions of Middle and Upper-Middle Aged Community Dwellers: Evidence from the Yakumo Study.

Aim: To compare the cognitive and physical abilities between upper-middle aged participants who have experienced Urination Dysfunction (UD) during last 4 weeks and intact control participants. Methods: In total 694 upper-middle aged participants (age ranged from 40 to 89 years old) were given a questionnaire for UD, cognitive tests (Digit Cancellation Test: D-CAT, and Logical Memory Test: LMT) and physical ability tests (Timed-get-Up and Go test: TUG and postural tremor test), individually. Results: We compared cognitive and physical abilities test performances between UD and Intact control group participants. Conclusion: The performance in a cognitive test, D-CAT, assessing prefrontal cortex function, and performance in tests of physical abilities including agility (TUG), were inferior in UD participants compared to the control group. However, there were no group differences in tests of LMT, physical balance, or BMI. These results strongly suggest that brain function is a risk factor for UD and health promotion staff of local governments should prepare proper measures to delay the onset of UD.

Illuminating the gendered nature of health-promoting activities among nursing staff in forensic psychiatric care.

When people in Sweden are sentenced and handed over to forensic psychiatric care (FPC), the authorities have overall responsibility for their health recovery. How nursing staff construct gender through their relations in this context affects their understanding of health promotion activities. The aim of this study was to illuminate, using a gender perspective, the understanding of nursing staff with respect to health promotion activities for patients. Four focus group interviews were conducted with nursing staff in two FPC clinics in Sweden. The study has a qualitative inductive design with an ethnographic approach. This study sheds new light on FPC in which its dual goals of protecting society and providing care are viewed from a gender perspective. When relationships within the nursing staff group and the nurse-patient relationship are justified by the goal of protecting society, gender becomes invisible. This might cause patients' individual conditions and needs for certain types of activities to go unnoticed. One of the implications of ignoring gender relations in nursing staff health promotion activities is that it risks contributing to gender stereotypes which impact on the nurse-patient relationship and the quality of care.

Developing and Pilot Testing an Integrated Technology-Moderated Institutional Health Promotion Model Using Operational Research Approach.

The study aimed to develop and pilot test an Integrated Technology-Moderated Institutional Health Promotion Model for university staff in Nigeria. An operational research approach using mixed concurrent design was adopted to develop the model, and pretest-posttest method was used to evaluate the utilization and effectiveness of the developed model. The participants in the study were university staff. Health-promoting lifestyle behavior and health status were measured via the adapted Health-Promoting Lifestyle Profile II instrument. The emerging model (an Integrated Technology-Moderated Institutional Health Promotion Model, which is an Android phone app named Tertiary Staff Health Promotion App) was deployed. Data were collected before and 12 weeks after the app deployment. The quantitative and qualitative data findings were combined to develop an integrated technology-moderated institutional health promotion model as a means to enhance health-promoting lifestyle behavior and health status of staff. The result of the pilot testing of the model showed that the model enhances health-promoting lifestyle behaviors and improves the health status of staff. Nurses, especially in community/public health nursing practice, can provide innovative interventions to drive and enhance health-promoting lifestyle behavior and improve health status of workers and other population groups through effective use of information and communication technology.

Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity.

Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity.

Implementation trial of school staff health promotion: Polish experiences.

The paper presents the results of the trial implementation of staff health promotion in the Health Promoting Schools (HPS) programme in Poland. The design and key results of the summative evaluation of the 3-year project and activities of schools after completion of the project are described. Over 900 teachers and non-teaching employees from 21 schools participated in the project. Its purpose was to verify the schools' ability to take action related to the promotion of staff health in the HPSs in Poland. The results of the summative evaluation of the project were considered positive and promising. The percentage of persons who declared that they take greater care of their health, and teachers who described their health as very good, increased. Most employees introduced beneficial changes in their health behaviours. In all schools, changes in working conditions and personnel relations were introduced. Eighty-two per cent of teachers and seventy-five per cent of other employees had a positive attitude to the project and ninety per cent declared that the activities ought to be continued. Nearly all the schools' project leaders considered it a valuable initiative, had personal benefits and satisfaction from its implementation. After completing the project, 16/20 schools continued activities promoting the health of employees. Since the trial implementation of health promotion among school staff was considered a success, in 2016 some indicators relating to school staff health were included in the self-evaluation of HPS, and work began to prepare coordinators of regional and district HPS networks to work with the schools.

ANALISIS PROMOSI KESEHATAN DI PUSKESMAS KALIJUDAN TERHADAP PHBS RUMAH TANGGA IBU HAMIL

Infectious and non-infectious disease, Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR) are indicators of health status that their achievements have not been satisfactory. Various problems are closely related to behavioral factors. Behaviors that have a role in maintaining and improving health status is a Clean and Healthy Behavior (PHBS). However, the successful achievement of indicators PHBS is still far from the expected target. The aim of this study was to analyze the role of health promotion in the public health centers with the achievement of PHBS in pregnant women’s households. This study was an observational analytic with quantitative and qualitative approach. Quantitative approach with a sample of pregnant women, whereas qualitative informant was health promotion staff. Sampling was simple random sampling technique. This study used Pearson correlation test on quantitative data indicate that there was a relationship between health promotion of public health centers with the achievements of PHBS. Signifi cant value was 0.000 (α = 0.05). Qualitative study foundthat the role of health promotion in the health centers with PHBS achievement were realized through a series of health promotion programs, namely home visits, empowerment through partnerships, as well as organizing through UKBM.Keywords: health promotion, PHBS, pregnant women

Feasibility study of the Kinsey Institute Homework Intervention (KIHIS-UK) to promote correct and consistent condom use, RCUK

What is the problem? Rates of sexually transmitted infections (STIs) in England have increased by around 50% over the last 10 years, with about half a million new cases occurring every year. The health, social, and economic costs of STIs are huge. Untreated chlamydia, for example, can lead to pelvic inflammatory disease and infertility. The current estimated cost of treatment to the NHS is £620 million per year. The Department of Health has identified the need to reduce STI rates as a priority for improving sexual health and have recognised young heterosexuals as target 'at-risk' groups. Why do we need to do something? Although condoms can be protective against STIs when used correctly and consistently, there are many barriers to their use such as negative attitudes, reduced sexual pleasure, fit-and-feel problems, and erection difficulties. The effectiveness of condoms is also reduced by incomplete use of condoms (i.e. not using condoms from start to the finish of sex), which is more commonly reported by men who experience problems whilst using condoms. Many health promotion interventions try to improve knowledge and skills to increase use; results, however, have been mixed. Although there is some evidence that these interventions can be effective, in practice health promotion staff may not have the time or the money to use these. There is therefore an urgent need to develop quick but effective interventions to improve use experiences, increase consistent and correct use, and reduce sexual risk among young people. What are we going to do? We want to adapt a promotion programme which has been developed and tested in the US for use among young men in the UK. The US programme gives out condom kits (containing different condoms and lubricants) asks men to try out the condoms at home by themselves by completing various homework exercises. As they test each they are asked to think about their own pleasure and which condoms they lke best. Men then score/rate the condoms they use. The aim of the programme is for men to improve their skills by 1) finding the right/best types of condoms and lubricants, 2) testing techniques of applying them, and 3) by practicing with them in no pressure situations (on their own). In this study we want to see if the idea can be adapted for use with men in the UK to improve their skills in applying condoms and their pleasure in using them. To do this we will be speaking to young men and health promotion professionals to find out their views and help us modify and develop the components of the new programme. We will then invite young people's information and advice services in community and educational establishments in Hampshire and the West Midlands to take part and help recruit 50 young men aged 16-25 to test out the programme. What we will measure: We want to know if young men like the different elements of the programme and if it is possible to run our study in the different settings. We are also testing whether it is possible to do a larger trial to see if the programme can change men's views and use of condoms, and to estimate the costs, time, resources, sample sizes, outcome measures etc. needed to carry this out. At the end of the programme we will ask participants for their views about the study and what we asked them to do. This work will increase the likelihood of developing an effective promotion intervention, and to assess whether a larger trial is justified and appropriate.

Increasing Self-Efficacy Among Future Health Educators: An Exploratory Study Using Service Learning

Background. Service learning is a pedagogical tool that involves students delivering a service, linked to course learning outcomes, to the community and measured through acquisition of knowledge, attitudes, and skills along with overall satisfaction of the experience. Undergraduate students enrolled in a peer health education course, collaborated with campus health promotion staff, in a semester-long service learning project to plan, implement, and evaluate a campus-wide health fair. Purpose. The purpose of the study was to examine how participation in a service learning project affected students’ self-efficacy aligned with the seven Areas of Responsibilities (AoR) of Certified Health Education Specialists. Method. The multimethod design used pre- and posttest results and reflective writing samples to evaluate changes in students’ ( n = 58) self-efficacy related to the seven AoR of Certified Health Education Specialists. Students completed semistructured reflective journals responding to overall satisfaction, barriers to implementation, and significance of the learning experience and health fair on their professional development. Results. Results indicated students’ self-efficacy increased across all AoR, with the largest improvements reported in Areas III, V, and VI. Students described feeling competent responding to questions and directing attendees to available on- and off-campus resources. Results emphasized overall satisfaction with the service learning health fair project, uniquely the importance of applying information from the classroom setting to the real world. Conclusions. Service learning opportunities in classroom settings and professional preparation programs aid in preparing future leaders within the field of health education to exemplify the seven AoR with competency and confidence.

Political Challenges in Complex Place-Based Health Promotion Partnerships: Lessons From an Exploratory Case Study in a Disadvantaged Area of Queensland, Australia.

Settings-based health promotion involving multiple strategies and partners is complex, especially in disadvantaged areas. Partnership development and organizational integration are examined in the literature; however, there is more to learn from the examination of practice stakeholders' experience of intersectoral partnership processes. This case study examines stakeholder experiences of challenges in new partnership work in the context of a culturally diverse and socioeconomically disadvantaged region in Queensland, Australia. Health promotion staff and community representatives participated in interviews and focus groups, and the thematic analysis included observations and documentary analyses. Our findings highlight the retrogressive influence of broader system dynamics, including policy reform and funding changes, upon partnership working. Partnership enablers are disrupted by external political influences and the internal politics (individual and organizational) of health promotion practice. We point to the need for organization level commitment to a consistent agreed vision specifically accounting for place, as a cornerstone of intersectoral health promotion partnership resilience. If organizations from diverse sectors can embed a vision for health that accounts for place, complex health promotion initiatives may be less vulnerable to broader system reforms, and health in all policy approaches more readily sustained.

Assuring a strong foundation for our nation's public health systems

BackgroundA strong public health infrastructure is necessary to assure that every community is capable of carrying out core public health functions (assessment of population health, assurance of accessible and equitable health resources, and development of policies to address population health) to create healthy conditions. Yet, due to budget cuts and inconsistent approaches to base funding, communities are losing critical prevention and health promotion services and staff that deliver them. PurposeThis article describes key components of and current threats to our public health infrastructure and suggests actions necessary to strengthen public health systems and improve population health. DiscussionNational nursing and public health organizations have a duty to advocate for policies supporting strong prevention systems, which are crucial for well-functioning health care systems and are fundamental goals of the nursing profession. ConclusionWe propose strengthening alliances between nursing organizations and public health systems to assure that promises of a reformed health system are achieved.

Reorientation of health services: enablers and barriers faced by organisations when increasing health promotion capacity.

Issue addressed Primary healthcare settings are important providers of health promotion approaches. However, organisational challenges can affect their capacity to deliver these approaches. This review identified the common enablers and barriers health organisations faced and it aimed to explore the experiences health organisations, in particular Aboriginal organisations, had when increasing their health promotion capacity. Methods A systematic search of peer-reviewed literature was conducted. Articles published between 1990-2014 that focused on a health care-settings approach and discussed factors that facilitated or hindered an organisation's ability to increase health promotion capacity were included. Results Twenty-five articles met the inclusion criteria. Qualitative (n=18) and quantitative (n=7) study designs were included. Only one article described the experiences of an Aboriginal health organisation. Enablers included: management support, skilled staff, provision of external support to the organisation, committed staffing and financial resources, leadership and the availability of external partners to work with. Barriers included: lack of management support, lack of dedicated health promotion staff, staff lacking skills or confidence, competing priorities and a lack of time and resources allocated to health promotion activities. Conclusions While the literature highlighted the importance of health promotion work, barriers can limit the delivery of health promotion approaches within primary healthcare organisations. A gap in the literature exists about how Aboriginal health organisations face these challenges. So what? Primary healthcare organisations wanting to increase their health promotion capacity can pre-empt the common barriers and strengthen identified enablers through the shared learnings outlined in this review.