Promotion Practice Research Articles

Exploring promotion practices, impact on public servants’ commitment, efficiency, responsiveness, and goal attainment in Nigeria

This paper explored the influence of promotion practices on the commitment, efficiency, responsiveness, and goal attainment of public servants in Nigeria. Public sector organizations are vital for national governance and development, particularly in countries like Nigeria. The performance of public servants, who play a crucial role in policy implementation and service delivery, is significantly influenced by their perceptions of fairness and transparency in promotion practices. Despite the importance of these employees, they encounter challenges such as political interference, nepotism, and bureaucratic inefficiencies, which complicate promotion decisions. These issues can undermine employee motivation and overall organizational performance. This study draws on the Expectancy Theory of Motivation to investigate how various promotion practices, whether merit-based, seniority-based, or influenced by other factors, shape public servants' perceptions of reward expectancy and, subsequently, their work behaviors. The study is a cross-sectional survey. The research indicates that when promotions are viewed as merit-based, public servants exhibit higher levels of commitment, efficiency, responsiveness, and achievement of goals. In contrast, promotion systems perceived as politically biased or lacking transparency correlate with lower morale and diminished organizational outcomes. Using a survey of 1,216 Nigerian public servants, the study identifies significant demographic trends that influence employee perceptions and performance outcomes. The findings demonstrate strong correlations between transparent, meritocratic promotions and positive employee behaviors, including heightened job satisfaction, efficient task execution, and proactive goal pursuit. Conversely, opaque and politicized promotion practices result in disengagement, reduced efficiency, and poor alignment with organizational goals.Thus, it is imperative to strategically align professional development with promotion criteria. Policy reforms are essential to remove political influences from the promotion process. Advocating for changes that minimize bias and prioritize merit over political affiliation will foster a more equitable and objective system, ultimately benefiting both public servants and the communities they serve in Nigeria.

Teaching-learning process in the undergraduate nursing course: training in the perspective of health promotion from the point of view of Paulo Freire

Introduction: health promotion actions enable professionals to create strategies capable of preventing diseases and other health problems. It is extremely important that health professionals are trained and qualified to see beyond the health aspects, so that they can create plans that help the individual in their health and social aspects, as well as developing quality care practices. Objective: to analyze the process of student training in the field of nursing aimed at promoting the health of adolescents from the perspective of Paulo Freire’s concepts. Methods: this is a descriptive study based on a qualitative approach conducted in accordance with the COREQ international guideline for qualitative research, carried out in three municipalities: Juazeiro do Norte, Crato and Iguatu, both cities in the Brazilian state of Ceará. Results: the health training process is geared towards building passive students of knowledge, trained to have a concept of promotion focused only on health issues, with a focus on well-being and quality of life. Conclusion: health promotion practices for adolescents are still incipient in health training, as there is still a focus on the use of traditional methodologies in theory and in practice the prioritization of ministerial programs. However, it is noteworthy that although the participants have broad perceptions of health and health promotion, there is still traditional training, as well as the application to the adolescent public.

Genome-wide identification of root colonization fitness genes in plant growth promoting Pseudomonas asiatica employing transposon-insertion sequencing

BackgroundPseudomonas spp. are well-studied plant growth promoters, particularly in the context of root colonization. However, the specific genetic factors that determine its fitness in the rhizosphere remain largely unexplored. This study breaks new ground by employing transposon insertion sequencing (Tn-Seq) to identify the genetic factors in Pseudomonas asiatica JR11 that are crucial for colonizing corn roots.ResultsWe created a transposon mutant library of P. asiatica JR11 with 91,884 insertion sites and subjected it to three consecutive enrichment cycles within the corn root system. A total of 79 genes were identified as essential for root colonization (negatively-selected), while 22 genes were found to counteract root colonization efficiency (positively-selected), with both sets being commonly present across all three cycles. These genes involve amino acid metabolism, cell wall biosynthesis, and protein functions. Additionally, we found four negatively-selected and four positively-selected hypothetical proteins that consistently influenced root colonization fitness.ConclusionsThe identification of these molecular determinants opens up exciting possibilities for further research. Understanding these pathways could lead to the development of novel strategies for enhancing the fitness of P. asiatica JR11 during corn root colonization, with potential implications for plant growth promotion and agricultural practices.

“Equal pay for equal work”: Exploring the gender pay gap in radiology

Among the enduring disparities confronting the United States is the gender pay gap. Women experience lower wages than their male peers in nearly every major occupation, including medicine, and this further underscores how gender-based inequities within the practice of radiology are wide regarding pay, promotion opportunities, and leadership representation in diagnostic and interventional radiology. This review article analyzes the historical and current data for the gender pay gap in radiology relative to other medical specialties, as well as the influence of other intersecting factors, such as race or ethnicity. The manuscript identifies key root causes of the pay discrepancies, including underrepresentation of women in leadership positions, deeply held biases, stereotypes, and inequities in promotion practices. Several strategies have been explored to tackle these challenges, encompassing enhancing pay transparency, reinforcing the commitments of institutions to pay equity, and advocating for systemic changes.

Awareness and practice of mental health promotion among students at the University of Calabar, Nigeria. Authors

Background: Mental health is vital to university students' overall well-being and academic performance. In Nigeria, cultural and institutional barriers often limit mental health awareness and support. This study explores the awareness and practices of mental health promotion among students at the University of Calabar, Nigeria, to address gaps and improve intervention strategies. Materials and Methodology: A mixed-methods approach was adopted, utilizing quantitative surveys (n=500) and qualitative interviews (n=25) with students and university staff. Data collection focused on mental health awareness, help-seeking behaviors, and the accessibility of mental health services. Quantitative data were analyzed using descriptive and inferential statistics, while thematic analysis was applied to qualitative responses. Results: Findings revealed that while 60% of students were aware of basic mental health issues, only 30% actively engaged in mental health-promoting practices. Significant barriers were identified, including stigma, lack of information, and cultural beliefs. Additionally, 45% of students associated mental health challenges with spiritual causes. Female students demonstrated more positive attitudes towards seeking help than males. Only 12% of students had accessed professional mental health support, with most relying on informal sources such as friends or religious leaders. Conclusion: The study highlights significant gaps between mental health awareness and practice among University of Calabar students. Addressing stigma, increasing the visibility of mental health services, and integrating mental health education into university curricula are critical steps. Evidence-based recommendations for promoting mental health include peer-led initiatives, enhanced accessibility to services, and culturally sensitive interventions.

The Role of the Public Health Workforce in Securing Political Commitment for Tackling Childhood Obesity in Local Government

Local government is well placed to provide leadership for the national ambition in England to halve childhood obesity by 2030 and has delegated authority for many policies thought necessary for effective action. However, with currently constrained local government finances, resources may not be prioritized for the wide range of policies and interventions necessary. Thus, local political commitment is vital for directing local government investment to tackle the issue. This qualitative study investigated how political commitment has been demonstrated in local government, the strategies used to build such political commitment, and the role of the public health workforce. Public health staff from 13 local authorities participated in semi-structured telephone interviews using questions informed by a conceptual framework composed of five previously defined levels of political commitment: rhetorical, institutional, operational, embedded, and system-wide. Thematic analysis showed that public health officers secured a political commitment by framing childhood obesity in line with existing priorities to build support among councillors in a position to advocate for the issue. Public health officers also engaged with multiple stakeholders, gathering data and insights to develop operational and embedded commitment. The study shows that effective health promotion practice requires a skilled and committed public health workforce, acting as policy entrepreneurs to secure system-wide political commitment in local government by proactively navigating local governance and policy processes, to build in opportunities for feedback and accountability.

The gift of health promotion in a celebration: A descriptive observational study of community baby showers on YouTube

Introduction: Although community baby showers have persisted as a global health promotion practice for infants and their families over the past decades, to date there is no study that has evaluated coverage and engagement of community baby showers across social media as a rising global health communication medium in this contemporary digital era. It follows that the goal of this study sought to fill this gap by examining the existing state of coverage for community baby showers on social media utilizing view count as an engagement metric. Methods: In this cross-sectional, descriptive and observational study, we conducted a content analysis of the top 100 most widely viewed videos populated on YouTube at one conceptual point in time that covered community baby showers. to determine the most prevalent sources, formats, and content represented across this sample of videos. Results: Many of the videos were published by nongovernmental / organizational sources (n=86) and among them, the majority were in the form of news reports (n=59). Content across these videos presented a diversity of community stakeholders and entities involved in the development and implementation of community baby showers, many which were both for-profit and non-profit organizations (n=72). There was substantial coverage of a wide range of resources and services for prenatal and postnatal care delineated across all of the videos in this sample. Several videos (n=39) covered increased support building for families of infants. Notably, these videos cumulatively generated a low number of views (N=73,036) which yields clinical, educational, and public health implications. Conclusion: Recommendations to partner with news organizations and utilize content that generated greater viewership as facilitators in increasing capacity to reach, engagement and impact of community baby showers are presented to optimize infant health outcomes, reduce infant mortality, and heighten access to resources and support for infants and their families worldwide.

Global trends in importance of 24-hour movement behaviors to pediatric health: Implications for South Korea.

Cultivating a 24-hour movement behavioral profile conducive to health and well-being, marked by adequate levels of physical activity, limited screen time, and sufficient sleep, has emerged as an important avenue for promoting pediatric health. We aimed to provide evidence of this potential, this multiphase, multimethod, and integrative review comprehensively investigated the global trends in health promotion initiatives and status of the Korean pediatric population. This integrative review comprised three phases employing various review methods: an environmental scan of existing guidelines for 24-hour movement behaviors worldwide, a rapid review of physical activity-related indicators from Global Matrix data, and a systematic review of 24-hour movement behaviors among children and adolescents in South Korea. The growing recognition of a holistic approach to the 24-hour movement behavior paradigm in pediatric health promotion has led to the establishment and adoption of 24-hour movement guidelines in different countries and by the World Health Organization (WHO). Korean health authorities have also responded to this need by releasing a translated report of the WHO guidelines for physical activity and sedentary behavior as well as the 2024 update of the Physical Activity Guidelines for Koreans. Accordingly, actions must be followed in policy, research, and practice. This is critical considering that Korean children and adolescents exhibit an unfavorable profile of 24-hour movement behaviors compared to the global average. Among those aged 0-6 years, the weighted averages for guideline adherence were 18.2% for physical activity, 38.1% for sedentary behavior, and 76.2% for sleep. For those aged 12-18 years, the weighted averages for guideline adherence were 20.4% for physical activity, 55.9% for sedentary behavior, and 26.2% for sleep. Building on these current findings, this integrative review provides three priorities for pediatric health promotion policy and practice and three recommendations for future research.

Enhancing stroke awareness in schools: efficacy of the HOBIT program in Czechia’s disadvantaged areas

Abstract Background For stroke treatment to be effective, it must be given as soon as possible. Delays are often caused by stroke bystanders failing to recognize symptoms and activate emergency medical services (EMS). This is especially a problem in socially excluded localities. This study evaluated the efficacy of a school-based intervention (HOBIT) in improving determinants and behavior intentions of EMS activation for suspected stroke in Czech socially excluded localities. Methods The quasi-experiment was conducted from May to June 2023 in the Moravian-Silesian region, Czechia. Schools were allocated to the intervention or control group (1:1). The HOBIT is a school-based intervention used to change health-seeking behavior when stroke is suspected. The primary outcome was the percentage change from the pretest to the follow-up test in the intervention group compared to the control group. The primary outcome was assessed in 4 domains: 1) knowledge, 2) behavioral intentions, 3) self-efficacy, and 4) outcome expectations. The intervention and control groups were compared using an unpaired t-test. Results We recruited 138 students aged 10-16 from 4 schools. The absolute differences in improvement between the control and intervention groups were 18% (95% CI 9-26, P < 0.001) for knowledge, 15% (95% CI 2-26, P = 0.01) for behavioral intentions, 6% (95% CI -4-15, P = 0.24) for self-efficacy, and 13% (95% CI 5-21, P < 0.001) for outcome expectations. The subgroup analysis showed that the intervention effect on self-efficacy, outcome expectations, and stroke behavior intentions was significant only in females. Conclusions The HOBIT improved stroke determinants and behavior intentions of EMS activation at schools in socially excluded areas. This study presents a health promotion practice that has the potential to improve stroke outcomes on a community level. It underscores the potential of school settings as an appropriate way to reduce health inequalities in socially excluded communities. Key messages • The HOBIT intervention improved determinants and behavior intentions of EMS activation for suspected stroke among students in socially excluded localities. • The study underscores the potential of school settings in reducing health inequalities and improving stroke-related outcomes in socially excluded localities.

Developing mental wellbeing promotion practices in Finnish primary schools: The CONSENSUS project

Abstract Issue/problem Schools constitute a key arena for promoting mental wellbeing among children and adolescents, and the Finnish welfare state has many beneficial structures in place for promoting mental wellbeing in schools. However, as mental health problems are prevalent, the need to advance this work is vital, ideally applying a holistic approach focusing on school-family interaction. Description of the problem The Finnish CONSENSUS project (2021-2025) focuses on the development of new practices and collaboration models in mental wellbeing promotion, targeting pupils in 13 primary schools in the Ostrobothnia region. The project answers question such as: What focal areas are prioritized by stakeholders in the development of mental wellbeing promotion in schools? How do participatory principles contribute to the development process and related outcomes? Results In 2024, a synthesis of previous project results (interviews, focus groups and longitudinal survey data collected among pupils, school personnel, school health care services and parents) was generated. The synthesis encompasses 20 possible priority areas to focus on in the development of mental well-being promotion actions, which are ranked by stakeholder representatives utilizing Delphi methods. Some pinpointed priority areas are implemented and evaluated in collaboration with self-selected schools during the academic year 2024-2025. Lessons Results highlight priorities in the development of mental wellbeing promotion in Finnish primary schools and describe focal areas being piloted, also illustrating opportunities and challenges when implementing participatory principles in action research projects. Key messages • Project results highlight prioritized areas in the development of mental wellbeing promotion in Finnish schools, as well as new initiatives currently being piloted. • The project approach emphasising participatory principles provides lessons for other initiatives focusing on mental wellbeing promotion development in schools.

Managing Pharmaceutical Promotion Mix in the Rise of Social Media

ABSTRACTA manufacturer of a branded prescription drug typically uses traditional promotional tools to communicate with consumers (i.e., direct‐to‐consumer advertising) and physicians (i.e., detailing, sampling, and journal advertising). These promotions seek to enhance brand drug visibility and, eventually, increase brand sales. As medical communication norms generally dictate how healthcare information is communicated, the emergence of social media challenges such norms and potentially inflates (or deflates) the efficacy of pharmaceutical marketing communication. In such situations, a crucial research question revolves around how marketers will adjust their promotional strategies. In this study, the authors analyze the longitudinal data of 41 brand drugs from 7 therapeutic classes between 2007 and 2014. Through the lens of signaling theory, they empirically show that the volume and valence of social media posts can enhance or hinder the sales impacts of different promotional activities. Specifically, the volume and valence of social media posts have the potential to amplify the sales impact of detailing and direct‐to‐consumer advertising, while diminishing the effects of sampling and journal advertising. The volume and valence of brand drug mentions as well as consumer passion toward the brand drug display similar effects on the efficacy of pharmaceutical promotions. The findings shed new light on conventional pharmaceutical promotion practices in the presence of social media and provide novel implications for promotion mix management.

Health beyond borders: the future of health promotion.

This article situates the field of health promotion in its current cutting-edge agendas around health and wellbeing; social and other determinants of health; complexity and its associated sciences; planetary health; and inclusion and diversity. However, it is also proposed that there are emergent dimensions that should be placed more deliberately on the agendas of health promotion research and practice. The piece offers three dimensions for noting health promotion futures: a cognitive, spatial and temporal one. The first is a non-anthropocentric appreciation of the complex interactions between geosphere, biosphere and anthroposphere that can be framed through a lens of governance and cosmology; the second one is established by humankind's journeys beyond the atmosphere into outer space; and the third one argues we - that is, the global health (promotion) community - need to account for temporal determinants of health, more consciously and conscientiously. The gazes seem beyond current agendas of health - but the article demonstrates how they are to become mission-critical aspects of contemporary and future worlds.

Interaction of perceived Chinese campus walkability and psychosocial factors on college students’ walking behavior

Walking, a physical activity beneficial for both physical and mental health, is influenced by various factors. Although previous studies have acknowledged that walking behavior is influenced by environmental and psychosocial factors, little is known about their interactions. Based on a socio-ecological model and focusing on Chinese college students, the purpose of this study was to examine the influence of campus walkability and psychosocial factors on college students’ walking behavior, including the interactions between these factors. This study seeks to enhance understanding of how to promote walking behavior through campus environmental design and psychological interventions. Multiple regression analysis was conducted on the questionnaire data. Findings revealed that campus walkability significantly influenced both walking behaviors, alongside psychosocial factors such as attitude, self-efficacy, perceived benefits, perceived barriers, and subject norms. Additionally, significant differences in interaction effects between these factors were observed for purposeful versus recreational walking behaviors. These interactions suggest that campus walkability more substantially promotes walking behavior in students with negative psychosocial factors, whereas its impact is less pronounced in those with positive psychosocial factors. The results underscore the need to focus not only on developing walkable environments but also on understanding the synergies with the psychosocial factors of target populations, offering crucial insights for campus planning and health promotion practices.

Bridging the gap: financing health promotion and disease prevention in Indonesia

BackgroundSpending on preventive care in low- and middle-income countries (LMICs), including Indonesia, is much lower than spending on curative care. There has been a pressing need to develop a clear pathway to increase spending on preventive care. This study aimed to assess the current financing landscape for health promotion and disease prevention in Indonesia and, subsequently, to develop a framework and recommendations for future health promotion financing in the country.MethodsWe adopted a mixed-method approach to gather information from all relevant stakeholders from December 2022 to June 2023. For the qualitative approach, we conducted (a) in-depth interviews (IDIs) and (b) focus group discussions (FGDs) with government officials at national and district levels, academics, professional organizations, healthcare workers in primary healthcare centres (PHCs), community health volunteers, non governmental organizations and private companies. For the quantitative approach, we applied a national online survey to healthcare workers involved in health promotion in PHCs. IDIs and FGDs were conducted with purposefully selected resource persons at the national level, five selected districts across Indonesia, and within 15 primary health offices and their communities. All qualitative data were recorded, transcribed, coded, interpreted, and then triangulated with national survey findings to develop the financing framework.ResultsWe identified gaps between the theory and practice of health promotion and disease prevention. These included the limited scope of health promotion initiatives, lack of direction and coordination between ministries, agencies and government levels, limited availability and capacity of health promoters, various yet uncoordinated funding resources and inflexibility in using the funds. To bridge the gap, the framework we developed suggests strengthening the legal and regulatory basis, strategically prioritizing financing arrangements, promoting evidence-based health promotion activities, developing the capacity of health promoters, enhancing the health financing information system and improving monitoring and evaluation.ConclusionsIdentified gaps and challenges in health promotion and disease prevention initiatives inform the development of our framework for future health promotion financing. This framework assists the national government in organizing national health promotion financing strategies and potentially serves as a valuable model for other LMICs.

"Not Only a Matter of Personal Interest"-Vaccination Narratives and the Model of Moral Motives in China and Germany.

Understanding vaccination decision-making processes is vital for guiding vaccine promotion within pandemic contexts and for routine immunization efforts. Vaccine-related attitudes influencing individual decision-making can be affected by broader cultural and normative contexts. We conducted 73 qualitative interviews with adults in China (n = 40) and Germany (n = 33) between December 2020 and April 2021 to understand COVID-19 vaccination intentions and preferences, and we analyzed transcripts using a five-step framework approach. During early analysis, we identified moral considerations in line with the tenets of the Model of Moral Motives (MMM) as a recurrent theme in the data. The MMM guided further analysis steps, particularly with its distinction between motives that are proscriptive (focus on avoiding harm by inhibiting "bad" behavior) and prescriptive (focus on actively seeking positive outcomes). Proscriptive vaccination arguments that compelled vaccination in our data included avoiding negative attention, being a law-abiding citizen, preventing harm to others, and protecting one's country. Prescriptive motives focused on self-efficacious behavior such as protecting the health of oneself and others via widespread but voluntary vaccination, prioritizing elderly and predisposed individuals for vaccination, and favoring a fair and equitable distribution of vaccines at the global level. In the interviews in China, both lines of arguments emerged, with a general tendency toward more proscriptive reasoning; interviews conducted in Germany tended to reflect more prescriptive motives. We encourage research and vaccine promotion practice to reflect moral considerations when aiming to understand public health preventive behavior and when developing tailored health promotion campaigns.

Weight perception and mental health disorders among adolescents of central-eastern Tunisia: A cross-sectional study.

The physical changes that accompany the onset of puberty demand a constant restructuring of the adolescent's perception of their body and may influence adolescents' mental health. To describe weight status perception and its association with socio-demographic characteristics (SDC) and mental health disorders among adolescents in a low and middle-income country (LMIC). We conducted a cross-sectional study in high schools in the urban area of the governorate of Sousse, Tunisia in 2018. We included in our study all students studying in selected classes in selected public high schools and who are consented to participate. Multinomial logistic regression was used to assess the associated factors to weight perception categories. The total number of students participating was 1399 with a response rate of 86.68%. The female sex was predominant (60.5% versus 39.5%). The mean age was of 17.03 ± 1.51 years. According to multivariate analysis, perceived weight categories were associated with sociodemographic factors such as gender and maternal educational level. Adolescents perceiving themselves as obese were at risk for severe depression (aOR = 0.40; p = 0.033). The BMI was associated with weight misperception: adolescents with normal weight tend to overestimate their weight (obesity aOR = 0.13, p = 0.017; overweight aOR = 0.1, p = 0.001). There was a clear discrepancy between the actual weight status of the teens and their self-perceived weight. Adolescents are still growing both physically and mentally, and forming their self-image. Thus, health promotion practices designed to create accurate perceptions of current body weight need to be part of prevention efforts.

The Perniciousness and Promise of School-Based Mental Health Service Delivery for Youth.

Rates of child and adolescent mental disorder have risen sharply while access to community-based mental health care options continues to be elusive for many families. Substantial and persistent barriers to community-based mental health care have prompted multiple stakeholders to pursue an approach that emphasizes health promotion and intervention practices within the context of ecologically valid and more accessible environments. The most prominent of these environments has been schools that can serve as local and centralized access points to various services, including mental health care. The rapid expansion of school-based mental health service delivery systems, however, carries both risk of perniciousness as well as significant promise with respect to effective and equitable care. This article summarizes key concerns surrounding school-based mental health service delivery systems, including non-beneficence and harm, support disparities, unsustainable implementation, oppressive school climate, and linkage to punitive and discriminatory practices. Broad-based recommendations to help realize the promise of effective and equitable care for students with mental health and behavioral challenges are also presented vis-à-vis each of these concerns. At the same time, natural tensions between various mandates assigned to schools as well as between schools and their surrounding communities will need to be addressed to reach the full potential of school-based mental health service delivery systems.

Integrating scientific recommendations for the development and promotion of junior elite athletes in Germany – an analysis of sports policy documents

ABSTRACT This study examines the integration of holistic talent development goals into the sports policy documents of governmental and non-governmental sports organisations in Germany. More specifically, it analyses (1) the extent to which talent development and promotion goals of key actors involved in junior elite sport reflect scientific recommendations, and (2) how these goals differ between key actors. Different goal dimensions of holistic talent development were explored namely long-term sporting development, competitions, dual career, personal development and wellbeing. To this end, document analysis was conducted for 30 sports policy documents published by 22 key actors (federal and state ministries, sports confederations and sports federations) involved in talent development and promotion in Germany and analysed using quantitative content analysis. The results indicate that political institutions in Germany recognise and respect the autonomy of sports to specify their operational goals in talent development policies. The sports organisations’ documents present a fragmented picture in terms of the integration of scientifically recommended goals. While the German Olympic Sports Confederation (DOSB) largely aligns with holistic goals, no comprehensive and systematic knowledge transfer seems to have taken place to regional confederations and sports federations, in which organisational perspectives appear to be influential. This study extends the literature on knowledge transfer of sports science to a policy perspective and offers valuable insights into the integration of scientifically recommended goals in talent development and promotion policies, both for science and practice.

Nurses' health promotion practices in rural primary health care in Nigeria. A qualitative study.

Nurses play a vital role in providing high-quality primary healthcare and health promotion services. The state of research highlights their often complex operational realities and shows the need for an evidence-based understanding of nurses' perspectives on health promotion practices, especially in low-resource settings. This study focuses on how community health nurses in rural primary healthcare centers in Nigeria perceive their health promotion role and the opportunities and challenges of, and potential entry points for strengthening, their practice. A sample of 10 nurses from eight rural primary healthcare centers in eight local government areas of Anambra state, Nigeria, was purposively selected. Data were collected via semistructured telephone and written interviews and analyzed by qualitative content analysis using a deductive-inductive approach. Nurses emphasized their commitment to supporting patients and communities to develop skills and take control of their own lives. Nurses described their role as facilitators of behavioral and environmental change, individual and community empowerment facilitators as well as social activists. Factors that enhance the health promotion practice of nurses include adequate skills, sufficient human and material resources and community support and participation. Inhibiting factors included insufficient funding, poor working conditions, staff shortages, high workload, lack of training opportunities and low participation of community members. Overcoming challenges and facilitating health promotion activities in rural communities require bolstering nurses by providing further training opportunities for enhancing their health promotion competencies and creating supportive environments. Future research should focus on how to strengthen nurses' health promotion efforts through interprofessional and intersectoral collaboration.

“Round Peg in a Square Hole”: Lessons from Community Health Promotion Practice on Dynamics of Accountability, Reporting and Evaluation, and Governance

This paper presents results from a small-scale institutional ethnography study of reporting requirements and evaluation practices in two urban community health centers (CHCs), as a sample of community-based nonprofit organizations that focus on social justice and health equity. The study illuminated complex relationships among accountability, reporting and evaluation, and governance. Among the CHCs, reporting and evaluation practices consistent with goals of obtaining social justice and health equity were undermined by an imbalance toward funder-oriented functional accountability. Analysis of accountability and reporting practices as systemic factors shaping knowledge production, decision-making, and action revealed notable consequences for CHCs’ health promotion practice. This paper proposes a wholistic accountability model to encourage equitable power relations in evaluation, enable participatory methods, and better align CHC knowledge production and governance systems with their health promotion goals. This study further adds to the growing literature supporting critical attention to nonprofit accountability in the context of systems change work.