Municipal Health Promotion Research Articles

Barriers to health promotion strategy work in Finnish municipalities.

This study's aim is to increase insights into the characteristics and conditions of municipal health promotion strategy work. Specifically, we aim to find barriers connected to strategy work, that is, creating and formulating municipal health promotion strategy documents, with the following empirical research question: What perceptions do municipal health promotion strategy actors have on barriers connected to low citizen participation, narrow cross-departmental collaboration and weak goal orientation in health promotion strategy work? Empirical data comprised 22 thematics, individual interviews collected from municipal managers, sector managers and municipal health coordinators. Analysis was conducted using content analysis. This study's findings showed that the main barriers impeding optimal strategy work conditions were administrators' sceptical views of participation and undeveloped administrative practices in inclusive citizen participation, inadequate leadership to unite actors and facilitate collaborative strategy work practices, and challenges in integrating various views into coherent strategic goals. Also, a need for boundary-spanning leadership that strengthens mutual interaction and creates a shared understanding of health promotion to build strategic collaboration and goal-oriented strategy work was revealed. Finally, to strengthen this leadership, influencing administrators' mindsets, behaviour and administrative culture is imperative.

Needs to Create Healthy Living Environments-A Two-Stage Delphi Survey in Europe to Identify Facilitating Factors and Barriers in Municipal Health Promotion.

(1) In the field of health promotion, municipalities offer opportunities to reduce SES-based health inequalities by addressing vulnerable communities. This research project aims to identify facilitating and inhibiting factors for the creation of healthy living environments. (2) After preliminary literature and qualitative research work, an online-based Delphi survey was conducted (December 2020–March 2021). This included the rating and commentating of 22 theses at two times, whereby the results of the first round of rating were visible to the participants the second time. (3) Twelve experts from seven European countries participated in the Delphi survey across both rounds (1st round: n = 37; 12 countries). The consensus was particularly clear with regard to providing resources, which, in turn, are especially necessary for involving target groups in health promotion. (4) The results illustrate the relevance of further cross-national exchange. Certain aspects however, such as the HiAP approach or strategies to reach disadvantaged groups, are still challenging in practice. In order to develop concrete recommendations, the theses need to be further operationalised. The Delphi method offers a suitable possibility to map international expertise in this field and with a focus on health equity.

State of evidence on municipal strategies for health promotion and prevention: a literature and database research (Scoping Review)

BackgroundThere are gaps in the research regarding the implementation and evidence of overall strategies for municipal health promotion addressing communities. The aim of this scoping review is to gain initial findings concerning theoretical models, approaches and evidence on strategies of municipal health promotion, which include self-care, mutual aid and healthy environments. The findings can enrich the development of health promotion services.MethodsA systematic scoping literature analysis was conducted in the databases PubMed, Web of Science, SAGE-Journals, Wiley-Online, ScienceDirect, LIVIVO and WiSo database as well as in a German project database. Evaluation studies and research reports on strategies in municipal health promotion were included and analysed qualitatively.ResultsAccording to our predefined inclusion and exclusion criteria, 15 hits were included. Capacity building, planning and the establishment of structures for health promotion were identified as theory-based models and approaches. None of the publications included showed clear evidence of the effects of municipal health promotion measures in terms of classically medically defined evidence.ConclusionsThe use of evidence-based theoretical models and approaches is no guarantee for the success of strategies for municipal health promotion. Challenges with regard to evidence are the execution of study designs corresponding to higher evidence classes and the isolation of effects of health promotion measures in complex environments.Trial registrationThis scoping review was not registered beforehand.

The development of a quality-assured action model for municipal health promotion

Abstract Background The creation of health-promoting living environments is a key strategy in order to minimise health inequalities, which have been increasing recently. Health promotion in municipalities offers many approaches in this context and is gaining importance on an international level. To structure the process of municipal health promotion, the aim of this research was to create a basis for action and to define requirements in the process. Methods A systematic literature research on models, approaches and tasks for health promotion in municipal settings was conducted in five databases such as Web of Science and EBSCOhost, and was supplemented by a manual search. All hits were filtered using inclusion and exclusion criteria. The design and presentation of the results were prepared based on the method of the Integrative Review. Results 262 publications were screened, sixteen of which were considered for analysis. On this basis, an action model for municipal health promotion was developed. It consists of four phases: Network Planning and Modification, Municipal Profiling, Municipal Strategy Development, Implementation and Evaluation. Other important identified aspects during the process are participation, project and network management, communication, evaluation and quality assurance. Conclusions The action model structures tasks and requirements in the process of municipal health promotion. The evidence also shows the importance of central coordination in municipal health promotion, which can be structured by the action model. The created model provides a new framework for a quality-assured and sustainable process and for a central coordinated municipal health promotion. Key messages Municipal health promotion should increasingly be established. Thereby, the adherence to a systematic, quality-assured process is important.

Policy Recommendations for healthy living environments and municipal health promotion in Europe

Abstract Municipalities can be the motor for health equity. But how should health promotion policies at all levels be formulated in order to mobilize local action for health? The Work package (WP) “Healthy Living Environments” in the Joint Action Health Equity Europe (2018 - 2021) focussed its work on this question. Based on a common Policy Framework for Action (PFA) and 14 Country Assessments (CA), actions were implemented representing a wide spectrum of policy responses to promote health equity through a municipal health promotion approach. At the end of the project, policy recommendations subsume the expertise and experience of the partners contributing to the sustainability of results. The policy recommendations were generated in 3 steps: Relevant project documents were collected and analysed, including the PFA, the CA, the reports and evaluation of actions and the results of a Delphi study conducted in the frame of the project. A synopsis of these documents was analysed in a workshop with the WP partners, resulting in decisions about the concept and necessary messages the policy recommendations should include. Some of the implemented actions and collected practices from the project were selected to elaborate the individual recommendations along these examples. A working group drafted the policy recommendations. After a second workshop to discuss the draft, the final recommendations were consented by the WP partners. The preliminary results include recommendations for different political levels, as health equity needs multi-level and multi-stakeholder health in all polices approaches along a quality-oriented process. A specific equity lens and a focus on existing frameworks, tools and capacity-building approaches is needed. Also the stronger deficits of municipal health promotion like the lack of scientific evidence or data at local level were identified. Ways of applicability and integration into the agendas of the audience will be discussed.

Basic training in “participatory practice” to foster municipal health equity in Germany

Abstract Participation is a key strategy in municipal health promotion and health equity. Short-term trainings for professionals and activists are missing in Germany. Therefore, a curriculum was developed together with experienced health promotion professionals and Public Health scientists. The course aims at the development of competencies as well as at practical training. Essentials to the curriculum are main principles of participatory approaches, academic and practice-based knowledge on methods of community-based research. The evaluation asked: -Which amount of in-class time and field training is needed? How can elements of ‘participatory training' be implemented? What support is given to transfer the course contents into practice? Two pilot series with in sum 25 participants were conducted. This led after evaluation to a five days' curriculum of training, divided on two workshops plus a midterm online-meeting. Training material on participatory approaches and step-by-step-descriptions on six methods were developed. An own practice project is embedded in the program. Experienced trainers introduced the methods and led seminar sessions. Elements of ‘participatory training' were implemented as follows: in the application as teams of two, in telling project stories to introduce new methods, supporting peer-to-peer-reflection and learning from each other. Support was provided through a virtual course platform for the group exchange and individual consulting. After evaluation informal meet-ups and monthly tasks were added to the course. In the pre-pandemic series all teams designed and started own projects. There is a high need in the field of municipal health promotion to implement community-based participation in Germany. Thus, classes were quickly booked out and evaluation showed a high motivation in working more participatory after the course. The curriculum is going to be published open access. Several health promotion associations are interested in offering the program. Key messages There is a high need in the field of municipal health promotion to implement community-based participation in Germany. The curriculum is going to be published open access. Several health promotion associations are interested in offering the program.

Identifying the potentials of the Place Standard tool in municipal health promotion in Europe

BackgroundMunicipal health promotion provides the opportunity to promote health equity and to design health-promoting living environments by developing individual strategies. The Place Standard tool is a participatory instrument to identify needs by asking citizens to evaluate their living environment. It is increasingly being implemented and recommended on an international level. The aim of the study was to identify the potential of the Place Standard tool for the development of strategies in a municipal context as well as to identify facilitators and barriers when designing these.MethodsWithin a qualitative study design, nine guided interviews were conducted with international experts who have applied the tool at a municipal level in Europe. The interviews were recorded, subsequently transcribed and analysed using MAXQDA software. The analysis was based on a qualitative content analysis according to Mayring, using a deductively developed category system.ResultsA total of 355 statements were analysed. Some refer to the fact that a comprehensive needs analysis is enabled by the Place Standard tool, empowerment can be promoted and that the development of strategies can only be carried out with follow-up work. Furthermore, some facilitating factors, e.g. participation and intersectoral cooperation, were described. Mentioned inhibiting factors are e.g. lack of support from political decision-makers and the Covid 19 pandemic.ConclusionsThe results of the research indicate that the Place Standard tool can be used to identify priorities for action regarding the needs of the population at a municipal level. They show that a successful strategy development for municipal health promotion strongly relies on the application of the tool in an overall process.Key messages The Place Standard tool can be used to analyse needs at a municipal level.In order to develop sustainable strategies for municipal health promotion, it should be applied in an integrated process.

Opportunities and barriers of creating healthy living environments – a Delphi Study

Abstract Comprehensive intersectoral and participatory strategies are required for successful implementation and functioning of local health promotion governance across Europe. 12 experts from 7 European countries took part in the two-stage online Delphi survey. 22 theses on key topics of municipal health promotion, prepared in a participatory process through interviews and a workshop with experts, were rated on a 10-point Likert scale (strongly disagree - strongly agree), and the confidence in answering and comments was queried. This procedure was repeated in the 2nd round. The response behaviour of the participants from the 1st round was made transparent to enable changes in opinion. In the quantitative analysis, the distribution of thesis rating was determined. The extent of consensus building was determined by comparing standard deviations. The comments were evaluated and summarized by content analysis. The outcome of the Delphi survey represents consensus-generated recommendations for the creation of healthy living environments in the municipal context. Consensus was reached on most of the theses. The experts agree on the need for an open structure of networks (mean 9.2; SD 0.6), a common vision in these networks (mean 8.3; SD 0.8), the resources required for organizing participatory processes (mean 9.5; SD 0.9) and the responsibility of all political areas for implementing an overall municipal strategy (mean 9.1; SD 0.8). The qualitative analysis provides indications that certain theses are assessed differently due to country-specific experiences and conditions. The results of the Delphi study provide a clear direction for generating recommendations. Depending on context and country, some contents are evaluated differently, which should be taken into account for the recommendations. In total, the study identified recommendations with cross-national validity that are beneficial for the creation of health promoting structures at local level.

6.L. Workshop: On the way to health equity – strengthening health promotion governance at local level in Europe

Abstract Health equity is influenced by the local social and physical environment people are living in. Municipalities all over Europe have a key role in shaping and addressing these living conditions. This is why one of the Work packages in the Joint Action Health Equity Europe focussed on how municipalities can contribute to health promoting and equity-oriented living environments. 17 national, regional and local public health authorities from 13 countries collaborated in this 3-year policy-level project, exchanged knowledge and practices, and implemented actions, tools and policies that promote healthy living environments. The first step in the project was to adopt a common Policy Framework for Action which summarizes the current evidence for healthy living environments and the role of municipalities. It provides a conceptual model for integrated municipal approaches. As a second step in the project, country assessments were conducted. Municipalities have a clear mandate to promote health. However, there is a big heterogeneity in resources, structures and capacities within and between countries. Key challenges are deficits in political commitment, accountability and intersectoral working. Yet, national and regional public health authorities have the potential to contribute a lot to support municipalities, like quality development, providing data, integrating health equity in existing structures, plans and approaches or collaborating with the broad range of existing stakeholders and networks. A synopsis from all the project documents, evaluation and an accompanying research project resulted in the final Policy Recommendations for Healthy Living Environments that this workshop presents, focussing on the following questions: How should health promotion policies be formulated in order to mobilize local action for health? What are the opportunities and barriers for health promotion at local level? How can the experience from JAHEE be integrated into the different structures of municipal health promotion in different countries? The first question will be taken up in the first presentation, presenting the development and contents of the final Policy Recommendations for Healthy Living Environments. The second presentation addresses the opportunities and barriers identified by a Delphi Study that has been conducted in the frame of the project work. The last question around sustainability and transferability of structures will be addressed through a roundtable discussion bringing in the experience from project partners and a local policy-maker. The workshop will give the possibility for stakeholders that were not involved in the Joint Action to inform themselves about the activities in different European countries. The broadening of the audience is also crucial for enhancing awareness of health equity and healthy living environments, increasing the acceptance and dissemination of the policy recommendations at national levels and developing a perspective for future actions. Key messages Municipalities can be the motor to build sustainable and equitable health promotion policies and structures. A common quality process has to be promoted and supported by frameworks, tools and capacity-building across political levels and sectors.

Municipal health promotion programs: is childhood obesity a concern at local level in Portugal?

Health promotion programs, targeted at distinct health outcomes such as childhood obesity, at local level are increasingly used worldwide. Therefore, there is a need to better understand the role of local governments (municipalities) as key public health promoters namely in the prevention of obesity in children. We aimed to provide some input regarding this issue in Portugal. First, we identified health-enhancing programs promoted by Portuguese municipalities in which children could participate. Then, we conducted a document analysis to provide clues about how municipalities conceptualized child health by retrieving information on which topics the programs were focused in, or acted upon, and identifying which socio-ecological model levels were addressed (or not) by each program. The 77 identified programs were promoted by 30 of the 308 Portuguese municipalities and only 11 programs addressed childhood obesity. Most programs focused in the individual health determinants and provided limited information which disabled its deeper analysis. Portuguese municipalities seem to disregard their potential as public health promoters. Childhood obesity is a major public health concern at national (and global) level but the same does not emerge locally. Municipalities are the closest government entities to the population, and it is their responsibility to ensure the population's quality of life, by addressing the social determinants and the physical environments. Therefore, municipalities should acknowledge health in their actions and delineate health improvement programs considering current evidence, specifically in the case of childhood obesity prevention that besides being a health problem in itself, is a risk factor for non-communicable diseases.

Continuing participatory research beyond the end of projects: participatory quality development in municipal health promotion

The limited timeframes of participatory health research (PHR) studies make it difficult to achieve the desired specific social changes through the projects. This is particularly true for the promotion of health equity in municipal settings. This article examines how participatory quality development (PQE) approaches can complement PGF in order to implement participation as aquality criterion in health promotion and to contribute to the sustainability of research results.Based on the structure and course of two participatory research projects on integrated municipal health promotion, quality development processes with older people and parents of preschool children are described.Structural and process design contribute significantly to the transfer of research results into practice and beyond the end of the project. In their structure and by continuously involving local partners and stakeholders, projects must ensure that the principles of participatory quality development are implemented in processes from the very beginning.Participation as aquality criterion in health promotion is now well established. However, there is adeficit in the implementation of this claim. PGF and PQE consistently implement the criterion but place high demands on structure and process design. It is recommended that participation principles should be anchored in cooperation agreements in the municipal partnerships and supportive frameworks for participatory approaches should be continuously developed.

Can municipal health promotion programs improve the health of the population? Review of foreign practices

Can municipal health promotion programs improve the health of the population? Review of foreign practices

Needs-based decision-making for municipal health promotion – an analysis across 13 European countries

Abstract Introduction In contradiction to many recommendations, municipal health promotion often does not address identified needs. In order to create healthy living environments, all the 13 countries participating in Work package 6 - healthy living environments (WP6) of the EU Joint Action Health Equity Europe have been implementing feasible actions since autumn 2019 based on a country-specific needs analysis. They were supported on a theoretical level by the contents of the WP6 Implementation Template. The aim is to find out if and how the decision-making process from needs-based planning to the implementation of these measures in municipal health promotion was successful. Methods In order to gain an insight into the process 'from needs to action' and to obtain information about the methodological approach to implementation, guideline-based interviews were conducted with the project partners of WP6. These, as well as accompanying questionnaire-based interim reports, were evaluated comparatively in terms of content analysis according to Mayring and with regard to concrete evaluation criteria, obstacles and success factors during individual steps that can be transferred to the Public Health Action Cycle. Results The interim reports of the participating countries show that the step from an identified problem and related needs to a concrete, tailored action is often difficult. The relevant aspects mentioned above will be analysed more detailed during the interviews. It is to be expected that further insights can be gained from this, especially on successful implementation processes. Conclusions The mix of reports and interviews with participants from different European countries offers a broad view of the decision-making process in local health promotion and makes obstacles and success factors transparent for other actors in this field.

Strategies for reaching vulnerable groups in municipal health promotion

Abstract Background Contrary to the actual goal of health promotion, which is to reach all population groups equally, groups with an already better state of health are reached by such health services whereas vulnerable or socially disadvantaged groups are often not reached. Specific offers for the latter, however, can lead to stigmatization by reducing them on certain risk factors. This results in a further increase of health inequalities. Methods As part of the Joint Action Health Equity Europe (Work Package 6), 13 participating countries have initiated individual projects since autumn 2019 to promote community health and health equity. These projects are based on previously systematically identified country-specific needs. Through content analysis according to Mayring of interim reports and interviews with the project partners, it will now be investigated which strategies have been used to reach vulnerable groups. Recommendations for other countries will be derived from this comprehensive experience. Results At this stage, the observations indicate that different strategies are chosen to reach different vulnerable groups. It can be assumed that direct connection to existing networks, which enable low-threshold access to these groups in their everyday life and participatory approaches that involve the target group in planning and implementation, seem to be promising. Conclusions The diversity, uniquely portrayed by the various projects from different European countries, provides an overview of the differences and similarities in the strategies used for reaching vulnerable groups from which approaches can be generated that are internationally relevant and transferable. Key messages Gaining access to vulnerable groups requires special consideration in health promotion. The results of the JAHEE project (WP6) show promising and diverse strategies for dealing with vulnerable groups.

Municipal Health Promotion as Part of Urban Health: A Policy Framework for Action

The link between health, socio-economic status and the living environment is increasingly moving into the focus of public health research and policy. The aim of the European Union’s Project “Joint Action Health Equity Europe (JAHEE)” is to enable countries to identify and implement needs-based measures to promote health equity. In one of JAHEE’s work packages, focusing on healthy living environments as a strategy to tackle health inequities, a Policy Framework for Action (PFA) has been developed. This article gives an insight into the core contents of the PFA, which are valid beyond the project boundaries for all actors that work at the intersection of community health promotion. The PFA was developed as a consensus document in a participatory process between the members of the work package and an interdisciplinary German team of public health experts. Results from project meetings of the partner countries as well as research findings and recommendations from field experts were incorporated. Reducing health inequalities in public health is a cross-sectional issue that needs to be addressed across all policy areas. The municipality setting is of particular importance in this context, as it offers many starting points and can coordinate between all relevant actors with an overarching strategy.

Models of Intersectoral Cooperation in Municipal Health Promotion and Prevention: Findings from a Scoping Review

Intersectoral cooperation is regarded as a promising strategy in setting-oriented prevention and health promotion for interdepartmental, joint efforts towards improved health equity. This paper deals with models of intersectoral cooperation in municipal health promotion. It frames the methodology and the central results of a literature and database search (on behalf of the Federal Centre for Health Education, BZgA) and presents the partial results regarding the models of intersectoral cooperation. Of 48 publications analyzed for the review, nine publications each present different models of intersectoral cooperation. The models describe typical processes in the context of the joint work as detailed step sequences and formulate general recommendations as success factors of intersectoral cooperation. With reference to the findings of the review, it can be concluded that models for intersectoral cooperation have not yet been systematized and consequently have not been researched for transferability into specific fields of practice.

Current capacities and challenges for equity-oriented municipal health promotion in Europe

Abstract As a basis for implementing actions in the frame of Work package 6 - healthy living environments in the Joint Action Health Equity Europe, each of the 13 participating countries conducted a country assessment. Methods The country assessments were self-assessments conducted in the first quarter of 2019. Partners received templates that had been agreed upon beforehand. Most of them conducted the country assessments by themselves or with the help of colleagues from their institutions as a desk-based review, and validated results with external experts and stakeholders. The first part of the country assessment referred to how municipal health promotion capacities are currently developed in the countries. Through the second part of the country assessment, each of the 13 countries selected up to 4 promising practices. Results In most of the 13 countries, municipalities have a clear mandate to promote health. However, there is a big heterogeneity in resources, structures and capacities of municipal health promotion within and between countries. One key challenge is the self-government of municipalities and health promotion as a voluntary task. One of the main problems is a deficit in intersectoral working. It appears that poor municipalities are even more disadvantaged in terms of capacities for municipal health promotion. 33 promising practices were identified, covering programmes, strategies, tools and interventions mostly from the local level, with a big variety of topics and approaches for health equity. Conclusions There is a big fragmentation and heterogeneity in municipal health promotion between and within European countries. National and regional public health authorities are in the position to contribute a lot to support municipalities. This can include promoting quality development, providing data, integrating health equity in existing structures, plans and approaches or collaborating with the broad range of existing stakeholders and networks.

Workshop: Creating healthy living environments in municipalities – European concepts, needs and actions

Abstract Health equity is influenced by the local social and physical environment we are living in. Municipalities all over Europe have a key role in shaping and addressing these living conditions. This is why one of the Work packages in the current EU Joint Action Health Equity Europe (JAHEE) deals with the living environment, and what municipalities can contribute to shape them in a health promoting and equity-oriented way. Current action in this field is fragmented, varies highly between and within European countries and strongly depends on political leadership. The Work package aims at providing a systematic and structured support for participating countries in taking action to create healthy living environments. In Work package 6 - Healthy living environments, 17 national and regional public health authorities from 13 countries collaborate to exchange knowledge, practices and implement actions that promote healthy living environments. This workshop aims at bringing together current knowledge and experience of why and how to create healthy living environments on the municipal level. Furthermore, it is supposed to inform what countries currently do and need to do in this field of action from the perspective of national public health institutes and ministries of health. And thirdly, an innovative local example of how to put the theory into practice will be presented. The “Should be”: The first presentation will describe the common conceptual basis for the project partners - the Policy Framework for Action. As was agreed upon among the project partners, the specific focus is a broad community approach towards health promotion that is steered from the municipal level. The “To be”: The second presentation will focus on common European challenges and potentials based on the country assessments that were conducted in the frame of the project, and how municipalities can be supported from the European, national and regional levels. Third and fourth presentations will present more in-depth country reports from Greece and Serbia describing the current capacities and potential for municipal health promotion. The “Good Practice”: The fifth presentation from the Netherlands will present an innovative approach from the City of Utrecht that is implemented in the frame of the Joint Action Health Equity Europe. The findings will be discussed using an interactive online-tool, and finally next steps, future actions and recommendations will be outlined. The workshop will give the possibility for stakeholders that are not currently involved in the Joint Action to inform themselves of the activities on the European level. The broadening of the audience is also crucial for enhancing awareness of health equity and healthy living environments as well as increasing the acceptance of the conceptual framework at national levels. Through exchange of knowledge and experience, potential new partners could be reached and involved in the project. Key messages The workshop brings together current knowledge of why and how European municipalities can create healthy living environments. The workshop presents what European countries currently do and need to do in this field of action.

Community-based interventions to enhance healthy aging in disadvantaged areas: perceptions of older adults and health care professionals

BackgroundThe number of older adults with different ethnic and socioeconomic background is steadily increasing. There is a need for community-based health promotion interventions for older adults that are responsive to ethnic and socioeconomic diversity among target populations. The aim of this study is to explore encounters between older adults living in disadvantaged areas and health care professionals in the context of community-based health promotion.MethodsQualitative methods were used involving interviews and focus groups with older adults (n = 22) and municipal health care professionals (n = 8), and multiple observations were conducted. Data were analyzed thematically.ResultsFindings show a gap between health promotion services and older adults due to a perception of services as being neither accessible nor acceptable in the context of complex health and psychosocial needs. Health care professionals reported trust, proximity and presence as fundamental factors for improving acceptability and accessibility of health promotion services.ConclusionsThere is a need to develop participatory approaches to engage older adults who live in disadvantaged areas in municipal health promotion services and to ensure that these services are relevant to these groups.

Association between Municipal Health Promotion Volunteers' Health Literacy and Their Level of Outreach Activities in Japan.

ObjectivesTo explore the association between health literacy and levels of three types of core activities among health promotion volunteers (developing a healthy lifestyle, outreach to family, and outreach to community members).Study DesignA cross-sectional, anonymous, self-administered postal survey of registered health promotion volunteers in the Konan area in Shiga Prefecture in Japan, conducted in January 2010. The study sample was 575 registered health promotion volunteers.MethodsThe survey collected data on health literacy, gender, age, education, self-rated health, perceptions about the volunteer organization, and perceptions of recognition in the community. The level of engagement in health promotion activities was measured by the extent to which the participants engaged in seven healthy behaviors and promoted them to family members and the community. The authors compared the health literacy level and other characteristics of the participants by core health promotion activities, using a chi-squared test, to examine the associations between demographic and other variables and the three core activities (healthy lifestyle, outreach to family, and outreach to community).Logistic regression analysis was conducted to examine the association between the degree to which the volunteers engaged in core activities (“healthy lifestyle,” “outreach to family,” “outreach to community”) and the levels of health literacy (low, medium, high) among health promotion volunteers, controlling for the effects of age, gender, health condition, education which may also have an impact on volunteers’ outreach activities.ResultsFour hundred and fifty-four questionnaires were returned, a 79.0% response rate. Excluding 16 cases with missing values on health literacy or the degree of health promotion activities, 438 research subjects were included in the analysis (valid response rate: 76.2%). Health literacy and a few demographic and other characteristics of the volunteers were associated with the three core health promotion activities. In bivariate analyses, active participation in the core activities was more prevalent among older volunteers (p<0.001 for all three activities). Self-rated health condition was associated with both outreach to family (p = 0.018) and community (p = 0.046). Years of experience as volunteer and perception of being recognized in the community also had statistically significant association with outreach to the community (p<0.001). In multiple logistic regression, those with higher level of health literacy were more likely than others to actively engage in outreach to family (OR = 1.70, 95% CI 1.03 to 2.80; OR = 1.76, 95%CI 1.04 to 3.00 for medium and high, respectively) and outreach to community (OR = 2.26, 95%CI 1.34 to 3.83; OR = 2.61 95%CI 1.49 to 4.58 for medium and high, respectively). Perception of being recognized in the community also had a statistically significant and positive impact on outreach to the community (OR = 1.52, 95%CI 1.17 to 1.99).ConclusionsVolunteers with higher health literacy were more likely to actively engage in outreach to family and outreach to community. Providing educational programs to improve volunteers’ health literacy may facilitate their work.