Health Promotion Principles Research Articles

Shaking out the cobwebs: insights into community capacity and its relation to health outcomes

The authors are health promotion and community development practitioners in the David Thompson Health Region of rural central Alberta, [Canada]. Like our peers, we struggle to carry out our practice in a way that honours the underlying values and principles of health promotion. Our experiences with two Regional health promotion programs over the past five years have led us to conclude that we must adopt and refine an emphasis upon community capacity building in our work. In this paper, community capacity building is defined and its importance for the work of health promotion and community development practitioners is outlined. We provide an overview of the literature on this subject and on related concepts such as asset based development, community competence, social capital, and civic infrastructure. Finally, we indicate some directions for further research. Ultimately, our work should provide guidance on how to deliver health promotion in order to more effectively strengthen and empower communities.

The common risk factor approach: a rational basis for promoting oral health.

Conventional oral health education is not effective nor efficient. Many oral health programmes are developed and implemented in isolation from other health programmes. This often leads, at best to a duplication of effort, or worse, conflicting messages being delivered to the public. In addition, oral health programmes tend to concentrate on individual behaviour change and largely ignore the influence of socio-political factors as the key determinants of health. Based upon the general principles of health promotion this paper presents a rationale for an alternative approach for oral health policy. The common risk factor approach addresses risk factors common to many chronic conditions within the context of the wider socio-environmental milieu. Oral health is determined by diet, hygiene, smoking, alcohol use, stress and trauma. As these causes are common to a number of other chronic diseases, adopting a collaborative approach is more rational than one that is disease specific. The common risk factor approach can be implemented in a variety of ways. Food policy development and the Health Promoting Schools initiative are used as examples of effective ways of promoting oral health.

Health promotion in the city: a structured review of the literature on interventions to prevent heart disease, substance abuse, violence and HIV infection in US metropolitan areas, 1980-1995.

To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, HIV infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. Selected articles listed as a main goal primary prevention of one of four index conditions; were carried out within a US city; included sufficient information to characterize the intervention; and organized at least 25% of its activities within a community setting. In general, programs reached a diverse population of low-income city residents in a variety of settings, employed multiple strategies, and recognized at least some of the principles of effective health promotion. Most programs reported a systematic evaluation. However, many programs did not involve participants in planning, intervene to change underlying social causes, last more than a year, or tailor for the subpopulations they targeted, limiting their potential effectiveness. Few programs addressed the unique characteristics of urban communities.

College Men's Health in Practice: A Multidisciplinary Approach

After a needs assessment indicated that male students underutilized campus health services, the San Francisco State University Student Health Service developed a coordinated complement of outpatient health services for men. The authors review their experience in developing, implementing, operating, and evaluating this ongoing clinical service. The needs assessment and subsequent program evaluation data suggest that male students on a large, culturally diverse, urban campus would respond favorably to targeted, multidisciplinary health initiatives that incorporate the principles of health promotion and disease prevention.

Who Knows the Streets as Well as the Homeless? Promoting Personal and Community Action through Photovoice

Photovoice is a process by which people can identify, represent, and enhance their community through a specific photographic technique. The purpose of the Language of Light Photovoice project was to enable men and women living at a shelter in Ann Arbor, Michigan to photograph their everyday health, work, and life conditions as a way to document their struggles and strengths; to promote critical dialogue through group discussion about their photographs; and to reach policy makers and the broader public about issues of concern to homeless people. The authors’ approach used photovoice, an innovative participatory action research method based on health promotion principles and the theoretical literature on education for critical consciousness, feminist theory, and a community-based approach to documentary photography. Photovoice involves community members’ taking pictures, telling stories, and informing policy makers about issues of concern at the grassroots level. The authors describe and analyze the project, offer recommendations to health promotion practitioners carrying out photovoice projects with society’s most vulnerable groups, and discuss implications for practice.

Promoting health: breastfeeding in PICU

Fran Turnbull demonstrates how health promotion principles were used to improve breastfeeding support in PICU

Continuous quality improvement and health promotion: can CQI lead to better outcomes?

Canadian health promotion organizations currently face two pressures. First, is the desire of health promotion organizations to seek methods which will help achieve health promotion goals. Second, external funders are increasingly likely to require that health promotion organizations adopt ‘quality’ procedures, such as Continuous Quality Improvement (CQI). This paper explores a set of questions that assess the potential benefits of CQI with respect to health promotion organizations. These questions include: Is the philosophy of CQI compatible with health promotion principles, values and beliefs? Is CQI methodology and approach applicable to health promotion? If there are no irresolvable conflicts between CQI and health promotion, will implementing CQI processes improve health promotion practice? In addition, the paper highlights several issues that health promotion needs to address before adopting CQI, including: the meaning and relevance of concepts such as ‘customer’ and ‘customer satisfaction’, within the context of health promotion; and the heavy emphasis that CQI places on data that are measurable and quantifiable. While further exploration and documentation are required before definitive resolution of these issues, a preliminary overview indicates that CQI, with some modifications, is compatible with health promotion in at least some circumstances and that, if these modifications are implemented, CQI could help health promotion achieve its goals.

Capacity Building and Community Enrichment: Evaluation for Sustainability

Evaluation is a continuing dilemma in health promotion initiatives. However, for projects to be sustained effective indicators and tools need to be implemented in order for resources and funding to be channeled into such enterprises. The capacity building model developed by New South Wales Health (1998) provided one model for evaluating a collaborative endeavor between the School of Nursing, Flinders University and Noarlunga Health Services, a generic community health centre in the southern urban/rural area of South Australia. The Community Enrichment Program (CEP), is in the final year of a four year funded project that aimed, in part, to determine what impact an integrated knowledge of Primary Health Care (PHC) would have on students and new graduates' nursing practice and, whether enough evidence would be generated to effect ongoing curriculum change. This paper considers capacity building in relation to the CEP and how the Ottawa Charter and the Jakarta Declaration are supported by this ideal. Argument is forwarded that workforce development, organizational structure and resource allocation, seen as tenets of capacity building, have been demonstrated in the CEP. Recommendations flowing from the project include the allocation of resources into a sustained, overt and integration of PHC philosophy and health promotion principles into nursing curriculum.

Current conceptualizations of mental health and mental health promotion.

Health promotion is generally agreed to be underpinned by a set of principles which distinguish it from other disciplines and professions. This paper takes these principles as the starting point for a review of the literature of mental health promotion. The aim is to clarify the ways in which mental health and mental health promotion are currently conceptualized, in order to identify areas where health promotion can make a unique contribution to complement that of other interest groups. In the first section, it is suggested that current definitions of mental health are inadequate for health promotion practice in that they either equate health with the absence of illness or present a culturally skewed, individualized and 'expert'-led version of what it means to be mentally healthy. The second section then traces the implications of these definitions as they emerge from the literature relating to mental health promotion practice. The paper concludes with a discussion of some ways in which health promotion specialists might begin to develop a mental health promotion agenda which is more consistent with health promotion principles.

Partnerships among Health Professionals and Self-Help Group Members

Occupational therapy practice in partnership with self-help groups is consistent with the principles of client-centred practice and health promotion. This qualitative research study examined the meanings and interactional mechanisms of effective partnerships with a theoretical sample of 47 health professionals, including seven occupational therapists, and 49 self-help group members. Inductive analysis of semi-structured interview transcripts resulted in a number of themes: roles of health professionals and self-help group members, relationships between them, characteristics of effective partnerships, tensions/barriers to effective partnerships, and strategies to promote partnerships. Themes with particular implications for occupational therapy practice include trust and trust building; knowledge, empathy and understanding; and the balance of power between health professionals and self-help group members. Effective partnership relationships require a continued commitment by occupational therapists, other health professionals and self-help group members to understand the experiences and perceptions of each other.

A congruent model for health promotion in occupational therapy

AbstractThe past two decades have seen the rise of new approaches, such as health promotion and managed care, and their gradual supplanting and reshaping of traditional health care delivery. To survive within the emerging system, occupational therapists must shift perspectives and adapt to the prevailing philosophies. But are the currently proposed strategies compatible with occupational therapy foundations? Contrasting health promotion, managed care and occupational therapy on their respective principles, paradigms, values, and applications, the authors discuss the congruence, or lack thereof, amongst the three.The authors describe the relationship between basic health promotion principles, the constructivist paradigm, occupational therapy values, and community‐based practice in a conceptually congruent sequence leading to more coherent interventions. They will also highlight the discrepancies between managed care and occupational therapy. Finally, they explore the use of participant‐action research as a means for providing innovative outcome measures. Copyright © 1997 Whurr Publishers Ltd.

Partnerships among Health Professionals and Self-Help Group Members

Occupational therapy practice in partnership with self-help groups is consistent with the principles of client-centred practice and health promotion. This qualitative research study examined the meanings and interactional mechanisms of effective partnerships with a theoretical sample of 47 health professionals, including seven occupational therapists, and 49 self-help group members. Inductive analysis of semi-structured interview transcripts resulted in a number of themes: roles of health professionals and self-help group members, relationships between them, characteristics of effective partnerships, tensions/barriers to effective partnerships, and strategies to promote partnerships. Themes with particular implications for occupational therapy practice include trust and trust building; knowledge, empathy and understanding; and the balance of power between health professionals and self-help group members. Effective partnership relationships require a continued commitment by occupational therapists, other health professionals and self-help group members to understand the experiences and perceptions of each other.

Raising Awareness of Postnatal Depression

Berwickwide Community Health Service (BCHS) conducted a project during National Mothering Week that set out to raise community awareness of Postnatal Depression (PND) and to assess the need for establishing a PND support group in Northern Casey, Victoria. Target groups included mothers of young children, general practitioners (CPs) and the general community. A reference group consisting of professional and community representatives was involved in the planning, implementation and evaluation of all strategies. Approaches used included health education, professional development, information development, creating supportive environments, supporting community action, intersectoral collaboration and policy development. The project highlighted the need for a PND support group in Northern Casey and was successful in terms of raising awareness of PND, information development and dissemination, and needs assessment of mothers in Northern Casey. Mothering Week provided an ideal opportunity to give a relatively small project a larger, more attractive profile and provided an ideal vehicle to introduce the 'heavy' issue of PND in a forum that celebrated and raised the status of motherhood. Although as health promotion practitioners we are not encouraged to run ad hoc events and to strive instead for sustainable outcomes, this project showed that applying health promotion principles to one-off events such as Mothering Week can be very useful in needs assessment and in determining characteristics particular to the target group. The increase in knowledge and skills and the sense of ownership that participants can experience through participation in such a project can also foster a sense of community spirit that lays the groundwork for more sustainable, future projects.

Delivering the goods, showing our stuff: the case for a constructivist paradigm for health promotion research and practice.

This article argues that there has been a tendency to empower the "conventional" positivist paradigm in health promotion research, often at the expense of confounding or ignoring much of health promotion practice. This article argues further that a "constructivist" research paradigm not only has the potential to resolve some of the tensions between research and practice in health promotion but also is inclusive of knowledge generated by the conventional paradigm. The usefulness of a constructivist paradigm is demonstrated through the use of four practice-based case examples drawn from actual community-based health promotion efforts. The congruence of a constructivist paradigm with the health promotion principles of empowerment and community participation are discussed. Finally, this article argues for the acceptance of the legitimacy of knowledge generated from the constructivist paradigm and concludes that this paradigm is more suited to the goals of current health promotion.

Empowerment strategies in nursing education: a foundation for population-focused clinical studies.

Building on the already substantial body of literature on education for population-focused practice, this article incorporates the teaching of empowerment strategies into this literature. These strategies provide a framework for teaching nursing students to promote the health of populations by shifting their focus of care to one that is compatible with principles of primary health care and health promotion within a context of health care reform. Since 1989, education for these shifts in practice has taken place within a clinical studies course on population-focused practice and has continued to evolve within an innovative nursing curriculum developed by The University of Victoria and its collaborative partners in nursing education in British Columbia, Canada. Faculty have worked to develop innovative teaching strategies and practica that provide students with opportunities to practice empowerment strategies with populations. Examples of how students have learned and practiced these strategies in a baccalaureate nursing program at the University College of the Cariboo in Kamloops, British Columbia, Canada provide useful illustration of the shifts in nursing education that are needed to shape the next era of health care.

Education and training in health promotion: theory and methods

SUMMARY Health promotion is evolving into a discrete concept with a definition commonly understood by all who use the term. This is to be distinguished from the kind of umbrella approach used by all manner of groups and disciplines to define their intentions or activities in this general area. Further, such a process of clarification is critical to progress and is dependent on having a theoretical basis through which research can be undertaken. In turn, the education of those engaged in health promotion can be expected to shape their skill range and perspective. We find, therefore, a kind of interdependent and reciprocal situation is developing. At the present time, for chronological reasons as much as anything else, practitioners of health promotion come from a variety of academic and training backgrounds. The process of enabling individuals to take control of their own health involves a wide spectrum of determining factors and hence expertise is very varied. Two key elements, for this writer at least, are these: the approach is positive and holistic rather than reductionist, and context is recognised as a major factor in health choices. This paper seeks to discuss the priorities for education against this background. It uses as resource the proceedings of a workshop on education and training held as part of a World Health Organization supported workshop held in Copenhagen in 1992. We find that most graduate level training is in dedicated Master level programmes that have considerable overlap with those in public health. Discussion will centre on whether we have sufficiently evolved our thinking to discriminate skill areas unique to health promotion that should be taught. The intuitive basis on which courses have developed to date will be examined. Finally, the paper asks whether or not the standardisation that may follow is in any way antithetical to the embracing principle of health promotion itself. This paper examines the implications of theory

“Let's grow up healthy:” A health education pilot project for primary schools in Lithuania

Health is markedly influenced by lifestyle health behaviours which require good practices or habits related to nutrition, exercise, the avoidance of smoking and alcohol, sleep and leisure activities, personal hygiene and dental hygiene. As a minimum, the adoption of healthy lifestyle habits requires health knowledge and a positive attitude to health, although these do not guarantee the performance of appropriate health behaviours because other factors may interfere. Children may be precluded from engaging in good lifestyle behaviours because of environmental factors such as their family circumstances. In addition, there are strong peer pressures that influence young people to adopt health risk behaviours such as smoking and drinking. Influential adults, such as parents and teachers, may also present role models that encourage children to try unhealthy lifestyle behaviours. Teaching children to lead a healthy lifestyle is an important task for present day Lithuania. Initial attempts at health education in the 1920's and 1930's were suppressed by the Soviet school and health care system. Although Soviet health care was formally based on principles of disease prevention, in reality, health promotion and health education were not supported. All resources were used to build hospitals and train doctors to treat disease. Despite the resources put into treatment, neither Lithuania nor any of the other republics of the former USSR compare favorably with the West on key health indicators including longevity or infant mortality.1 Unlike the former USSR, most countries in the West over the last few decades have devoted considerable attention to the promotion of healthy lifestyles among children and young people and have accumulated a rich experience about how to do so. For example, such projects can be mentioned as: Know Your Body in the USA and other countries,2,3 Westchester County Intervention Trial in New York, USA4, North Karelia Youth Project in Finland5, Oslo Youth Study in Norway6, Lifestyle Education Programme in Australia7, and Keep Your Body Healthy in Israel8.

Book Reviews : Principles of Health Education and Health Promotion, J. Thomas Butler, Englewood, CO, Morton Publishing Company, 1994

Book Reviews : Principles of Health Education and Health Promotion, J. Thomas Butler, Englewood, CO, Morton Publishing Company, 1994

Arthritis Self-management in Native Populations of British Columbia: An Application of Health Promotion and Participatory Research Principles in Chronic Disease Control

RÉSUMÉLa promotion de la santé et la recherche participative proposent aux scientifiques un défi fascinant: mettre à la portée de populations difficiles à rejoindre les bénéfices de l'adaptation, de l'implantation et de la diffusion des découvertes et innovations dans les domaines de l'auto-santé et de la constitution des réseaux d'entraide. Cet article présente quelques-unes des forces et faiblesses, de même que certains problèmes et controverses associés à une application de l'approche de promotion de la santé couplée à une recherche participative, auprès de populations autochtones, concernant l'auto-traitement de l'arthrite. Nous explorons aussi comment ces expériences pourraient être appliquées auprès des personnes âgées. Les premiers résultats de notre étude sur l'auto-traitement de l'arthrite dans les populations autochtones illustrent comment une recherche participative peut être implantée dans une population spécifique, et sont intéressants du point de vue des possibilités d'adaptation de ces stratégies de promotion de la santé dans des populations de personnes âgées ou des populations autochtones.

The Managed Heart Revisited: Health and Social Control

In this paper I investigate emotional labour in the field of nursing. I show how new ideologies of health promotion have become attached to the prior agenda and already-embedded relationships which structure health provision. Beginning with an outline of health promotion principles and policies the paper goes on to trace how the radical dimensions of health promotion philosophies are subverted in practice by discussing data from a research project into nursing roles in health promotion. I present the data to show how nursing's focus on relationships and relationship skills create divisions of knowledge and information between ‘expert’ discourses located in the institutions of health provision and the everyday agenda of the populations using their services. In the final section of the paper I argue that a focus on the deployment of emotion work in specific social and institutional contexts provides a perspective on emotions as resources that are consciously drawn upon by actors in order to achieve socio-cultural and wider political ends.