Health Promotion Work Research Articles

Contradictory discourses of health promotion and disease prevention in the educational curriculum of Norwegian public health nursing: A critical discourse analysis

Health care is under constant change creating new and demanding tasks for public health nurses. The curriculum for public health nursing students is controlled by governmental directives that decide the structure and content of their education. This paper analyses manifest and latent discourses in the curriculum, in order to reveal underlying governmental principles for how public health nurses should promote health and prevent diseases. A critical discourse analysis of the Norwegian public health nursing curriculum was conducted. The study indicates i) 'a competing biomedical and social-scientific knowledge-discourse', with biomedical knowledge dominating the content of the curriculum; ii) 'a paternalistic meta-discourse', referring to an underlying paternalistic ideology despite a clear focus on user participation; and iii) 'a hegemonic individual discourse'. Even though the curriculum stipulates that public health nurses should work at both an individual and a societal level, there is very little population focus in the text. Recent political documents concerning public health nursing focus more on health promotion, however, this is not sufficiently explicit in the curriculum. The lack of emphasis on social scientific knowledge, and the blurred empowerment and population perspective in the curriculum, can lead to less emphasis on health promotion work in public health nursing education and practice. The curriculum should be revised in order to meet the recent governmental expectations.

Student‐driven health promotion activities

PurposeThe aim was to examine how students in the arctic region of Sweden experienced creating, leading, and participating in student‐driven health promoting activities in cooperation with their teacher.Design/methodology/approachInspired by the participatory appreciative action research (PAAR) method 19 Swedish students, ages 10‐11 participated in health promotion work in the classroom through creating, leading, participating in and evaluating their own and their peers’ health promoting activities.FindingsStudents developed three themes and related activities which they felt helped them reduce stress and have friendly fun: “the friendly touch” (music and student massage), “the outdoor run for fun” (student physical activity in outdoors), and the sounds of well‐being (music).Practical implicationsThis paper provides a comprehensive understanding of how students experienced creating, leading, and participating in student‐driven health promoting activities in cooperation with their teacher, and reveals that when students were asked to choose health promoting activities, they were not only in line with existing research but were able to reflect on how to develop good practice. Students are competent to lead health promoting activities with the support of their teacher and participating in health promoting activities lead by their peers.Originality/valueThe empowerment‐based group assignment in this study offers an example of implementing health promoting activities in school to increase health literacy useful for health educators and teachers.

Predictors of Sun-Related Behaviors Among Young Women: Comparisons Between Outdoor Tanners, Fake Tanners, and Tan Avoiders

Objective: Skin cancer incidence continues to rise as a tanned appearance remains desirable, particularly among young women. Fake tanning provides a tanned appearance without exposure to ultraviolet radiation. In order to advance our understanding of the factors that contribute to long-term behavior change, this study explores determinants associated with different types of tanning. Participants: The sample included 162 female students from the University of Adelaide, Australia, aged 18–26 years. Data were collected in July 2010. Methods: The current study measured differences in skin type, skin cancer knowledge, unrealistic optimism, appearance motivation, and sun-protective and sun exposure behaviors amongst outdoor tanners, fake tanners, and tan avoiders through an online survey. Results: Differences were observed for skin type, skin cancer knowledge, unrealistic optimism, sun protection, and sun exposure. Conclusions: A “one-size-fits-all” approach to skin cancer prevention may not be appropriate; type of tanning behavior may need to be considered in health promotion work.

A journal for and with health promotion practitioners and researchers

Workshop participants were keen to know what we look for as editors. The best manuscripts are those that have a clear focus and tell a coherent story, answering specific questions using appropriate research methods. Good manuscripts have a title and abstract that accurately represent their contents, and are so interesting that they make us want to read on! Manuscripts based on quantitative studies need to report sample sizes sufficient to support the conclusions, should explicitly discuss potential biases or other limitations, and should provide enough information about methods so that the study could be replicated. Authors of qualitative studies should explain how their sampling strategies, data collection methods and analysis strategies were appropriate to answer their research questions, provide enough detail about methods to enable readers to evaluate quality, and demonstrate that the analyst has sought out variation and tried to prove themselves wrong (rather than looking only for favourable, expected or straightforward answers). The editorial team is especially keen to publish well-designed intervention studies. However, we also agree on the importance of qualitative research in health promotion, particularly for understanding how health promotion works and investigating the perspectives of research participants. We will consider theoretical pieces and essays, but these need to be well argued with reference to the relevant evidence base. Authors may consider writing a brief report rather than a full-length article: brief reports are an excellent forum for a single, interesting finding, a key idea or description of an innovative program or project.

Discourses and polarities concerning health promotion in the Brazilian health system

This paper presents theoretical reflections on health promotion in the Brazilian public health context. Some characteristics and problems of the international debate are highlighted, but our focus is the position of health promotion as it is discussed in the Brazilian health system. We follow the foucauldian perspective of biopower and resistence to discuss the selected texts and documents related to health promotion that were considered relevant for the purpose of this investigation. Health promotion is discussed as a field of discourses, practices, knowledge production and power. We concentrate our analysis on the debate proposed by collective health researchers on the repercussions of the Lalonde Report in the international Health Promotion Charts, and on the connexion between health promotion and the Brazilian health system. The discussion demonstrates that health promotion work requires constant attention and significant effort from managers, technicians, and health system users, and that each step forward reveals new challenges and calls for new actions.

The importance of context in the evolution of health promotion

The world has changed dramatically since the Ottawa Charter was developed in 1986. Contemporary health promotion responses continue to evolve and become more sophisticated in response to the multiple challenges created by an ever-changing world. This commentary discusses some of the challenges facing health promotion professionals today and some of the responses that are being developed to address them. The importance of contextual considerations for both the worker and the work of health promotion are emphasised. The author then suggests ways that organisations and individuals can meet modern-day health promotion challenges through specific courses of action.

Health promotion in Australian multi-disciplinary primary health care services: case studies from South Australia and the Northern Territory

This paper reports on the health promotion and disease prevention conducted at Australian multi-disciplinary primary health care (PHC) services and considers the ways in which the organizational environment affects the extent and type of health promotion and disease prevention activity. The study involves five PHC services in Adelaide and one in Alice Springs. Four are managed by a state health department and two by boards of governance. The study is based on an audit of activities and on 68 interviews conducted with staff. All the sites undertake health promotion and recognize its importance but all report that this activity is under constant pressure resulting from the need to provide services to people who have health problems. We also found an increased focus on chronic disease management and prevention which prioritized individuals and behavioural change strategies rather than addressing social determinants affecting whole communities. There was little health promotion work that reflected a salutogenic approach to the creation of health. Most activity falls under three types: parenting and child development, chronic disease prevention and mental health. Only the non-government organizations reported advocacy on broader policy issues. Health reform and consequent reorganizations were seen to reduce the ability of some services to undertake health promotion. The paper concludes that PHC in Australia plays an important role in disease prevention, but that there is considerable scope to increase the amount of community-based health promotion which focuses on a salutogenic view of health and which engages in community partnerships.

Percepção da enfermagem sobre condições de trabalho em unidades de saúde da família na Paraíba - Brasil

The objective of this descriptive, qualitative study present study was to describe and characterize nursing professionals’ perceptions regarding occupational accidents and the working conditions at Family Health Units in João Pessoa, Paraíba, Brazil. Data collection took place between October and December of 2010, through semi-structured interviews (with twelve workers) and content analysis (thematic). Four thematic categories were found: Occupational accidents (associated with the work nursing worker); Accident risks inherent to working at the Family Health Unit; The health of primary health care workers; The health promotion of workers and preventing occupational accidents at the Family Health Unit. In conclusion, the workers have an adequate perception regarding the theme, despite being subjected to unhealthy working conditions dealing with an overload of work and a lack of infrastructure and protective equipment. Descriptors: Family Health Program; Accidents, Occupational; Occupational Health Nursing; Occupational Health.

Booster Breaks in the workplace: participants' perspectives on health-promoting work breaks

Increasing sedentary work has been associated with greater cardiovascular and metabolic risk, as well as premature mortality. Interrupting the sedentary workday with health-promoting work breaks can counter these negative health effects. To examine the potential sustainability of work-break programs, we assessed the acceptance of these breaks among participants in a Booster Break program. We analyzed qualitative responses from 35 participants across five worksites where one 15-min physical activity break was taken each workday. Two worksites completed a 1-year intervention and three worksites completed a 6-month intervention. Responses to two open-ended questions about the acceptance and feasibility of Booster Breaks were obtained from a survey administered after the intervention. Three themes for benefits and two themes for barriers were identified. The benefit themes were (i) reduced stress and promoted enjoyment, (ii) increased health awareness and facilitated behavior change, and (iii) enhanced workplace social interaction. The barrier themes were the need for (iv) greater variety in Booster Break routines and (v) greater management support. This study provides empirical support for the acceptance and feasibility of Booster Breaks during the workday. Emphasizing the benefits and minimizing the barriers are strategies that can be used to implement Booster Breaks in other workplaces.

‘A lot of the things we do … people wouldn’t recognise as health promotion’: addressing health inequalities in settings of neighbourhood disadvantage

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.

Exploring the process of capacity-building among community-based health promotion workers in Alberta, Canada

Community capacity-building is a central element to health promotion. While capacity-building features, domains and relationships to program sustainability have been well examined, information on the process of capacity-building as experienced by practitioners is needed. This study examined this process as experienced by coordinators working within a community-based chronic disease prevention project implemented in four communities in Alberta (Canada) from 2005-2010 using a case study approach with a mixed-method design. Data collection involved semi-structured interviews, a focus group and program documents tracking coordinator activity. Qualitative analysis followed the constant comparative method using open, axial and selective coding. Quantitative data were analyzed for frequency of major activity distribution. Capacity-building process involves distinct stages of networking, information exchange, partnering, prioritizing, planning/implementing and supporting/ sustaining. Stages are incremental though not always linear. Contextual factors exert a great influence on the process. Implications for research, practice and policy are discussed.

The health promotion work of the district nurse: interpreting its embeddedness

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.

A Systematic Review of the Evidence Concerning the Economic Impact of Employee-Focused Health Promotion and Wellness Programs

To assess the evidence regarding the economic impact of worker health promotion programs. Peer-reviewed research articles were identified from a database search. Included articles were published between January 2000 and May 2010, described a study conducted in the United States that used an experimental or quasi-experimental study design and analyzed medical, pharmacy (direct), and/or work productivity (indirect) costs. A multidisciplinary review team, following specific criteria, assessed research quality. Of 2030 retrieved articles, 44 met study inclusion criteria. Of these, 10 were of sufficient quality to be considered evidentiary. Only three analyzed direct and indirect costs. Evidence regarding economic impact is limited and inconsistent. Higher-quality research is needed to demonstrate the value of specific programs.

The nature of nursing practice in rural and remote areas of Greenland

BackgroundThe Greenlandic Healthcare Reform (2010) required improved quality of services for health promotion, prevention of infectious and lifestyle diseases, family nursing and evidence-based clinical nursing.AimTo investigate current nursing practice in Greenland and to identify whether it meets the requirements of healthcare reform.DesignThis ethnographic study utilised documentary analysis, participant observation and qualitative interviewing carried out in remote areas of Greenland during 2011–2012. Eight registered nurses, four women and four men, aged between 35 and 55, participated in this study. Four were working at healthcare centres in towns and four were working at nursing stations in villages. The nurses were educated in Greenland or a Nordic country and had been practicing nursing for at least 2 years in an Arctic region. They were observed for 1–5 days, and subsequently interviewed. Interviews included in-depth questioning, based on emerging outcomes from observation. Interviews were recorded and transcribed; they were analysed within a phenomenological–hermeneutic approach.ResultsNurses in rural and remote areas navigate their health promotion and preventive work with conflict between health strategies and everyday realities, where unpredictable tasks often lead to prioritisation of urgent, acute work. There is interaction between personal and professional skills. Everyday life is characterised by opportunities and challenges in the grey areas, namely nursing, medical and social work.ConclusionThe nature of nursing practice in rural and remote Greenland is characterised by a high degree of variability and complexity, with a requirement for a wide range of knowledge and skills. Nurses need to be better prepared with regard to acute medical care, preventive care, social work, humanistic approaches and information technology to implement the ideology of health strategies.

Establishing a Health Promotion and Development Foundation in South Africa

South Africa has a 'quadruple burden of disease'. One way to reduce this burden, and address the social determinants of health and social inequity, could be through health promotion interventions driven by an independent Health Promotion and Development Foundation (HPDF). This could provide a framework to integrate health promotion and social development into all government and civil society programmes. On priority issues, the HPDF would mobilise resources, allocate funding, develop capacity, and monitor and evaluate health promotion and development work. Emphasis would be on reducing the effects of poverty, inequity and unequal development on disease rates and wellbeing. The HPDF could also decrease the burden on the proposed National Health Insurance (NHI) system. We reflect on such foundations in other countries, and propose a structure for South Africa's HPDF and a dedicated funding stream to support its activities. In particular, an additional 2% levy on alcohol and tobacco products is proposed to be utilised to fund the HPDF.

Integration of health protection and health promotion: rationale, indicators, and metrics.

To offer a definition of an "integrated" approach to worker health and operationalize this definition using indicators of the extent to which integrated efforts are implemented in an organization. Guided by the question-How will we know it when we see it?-we reviewed relevant literature to identify available definitions and metrics, and used a modified Delphi process to review and refine indicators and measures of integrated approaches. A definition of integrated approaches to worker health is proposed and accompanied by indicators and measures that may be used by researchers, employers, and workers. A shared understanding of what is meant by integrated approaches to protect and promote worker health has the potential to improve dialogue among researchers and facilitate the research-to-practice process.

Disability, sport and men's narratives of health: A qualitative study.

Very little research has been conducted that examines men, sport, masculinities, and disability in the context of health. Readdressing this absence, this article examines the health narratives told by spinal injured men and the work narratives do on, in, and for them. In-depth life history interviews and fieldwork observations with men (n = 17) who sustained a spinal injury through playing sport and are now disabled were conducted. Qualitative data were analyzed using a dialogical narrative analysis. Stories told about health characterized a style of embodied actions choices that anticipated a certain type of narrative, that is, an emergent narrative. The men's narrative habitus, fashioned through the process rehabilitation, predisposed them to be interpellated to care about health. To uphold hegemonic masculinities the men also did not care too much about health. The analysis also reveals the work narratives do on, in, and for health behavior, masculine identities, resilience, leisure time physical activity, and body-self relationships. Implications for health promotion work are highlighted. The article advances knowledge by revealing the emergent narrative of health. It reveals too for the first time the way certain contexts and masculine identities create a new subject of health that cares about doing health work, but not too much. Building on the theoretical knowledge advanced here, this article contributes to practical understandings of men's health and disability by highlighting the potential of narrative for changing human lives and behavior.

Health inclusive education

When considering the relevance of contemporary learning theories to health education and promotion work in schools, it is necessary to inspect the kinds of discourses used therein for how they understand and thereby constitute people and their worlds. For instance, contemporary educational practices, teaching and learning included, are dominated by constructivist theory and its person-in-the-world purview. It follows that from these discourses potentials for inclusion (and exclusion) emanate helping to constitute the very form and nature of our schools. This paper contributes to an ongoing explication of existing and persisting discursive conditions in the cultural politics of education focussing on how these inform teaching and learning in health education. By critically examining the purposes of contemporary educational practice and the theoretical precepts which support its activities, we move closer to being able to realise the possibilities of a refocussed kind of work. Such practice is dedicated to engaging meaning as it is applied by those in the living of their daily lives and accordingly decentres teaching and learning to enable health inclusive education.

Health promotion by primary care nurses in Australian general practice

The pressures brought about by the increasing prevalence of poor health among some population groups as well as the rise in prevalence of chronic and complex conditions requires a nursing workforce skilled in health promotion. Primary care nurses have increasingly important roles in general practice settings but there is little exploration of the nature or extent of their health promotion work. This paper reports on a survey that investigated primary care nurses' perceptions of their current and potential roles in health promotion in general practice settings. The survey respondents were primary care nurses in general practice. 78 nurses responded to advertisements seeking participation, and 58 surveys were completed and returned. Data were analyzed through a framework of downstream-upstream health promotion actions. We found that the health promotion practices of primary care nurses were most commonly in the downstream realm of disease prevention and health education but nurses aspired to take on roles in more upstream work of partnerships and collaboration. Nurses' opportunities are undoubtedly constrained by both the general practice setting and their educational preparation. However, nurses were very positive about the opportunities that their role and position offered for expansion of their health promotion work.

Sexually transmitted infections in men who have sex with men

For the first time in 10 years, there has been a fall in the number of diagnoses of sexually transmitted infections (STIs) in England; new diagnoses fell by 1%. Infection rates continue to grow among gay men and other men who have sex with men. Men who have sex with men are at more risk of developing an STI than other men in the population. This article considers the overall trends and diagnoses of STIs in England. A focus in particular on men who have sex with men is provided with an emphasis on lymphogranuloma venereum. Data is presented in order to provide the nurse with an overview of trends and the burden of STIs on this group of people; STIs are still on the increase in men who have sex with men. This article makes recommendations for action and emphasises the important role of the nurse in making men who have sex with men a priority for targeted HIV and STI prevention and health promotion work.