Health Promotion Principles Research Articles

Promoting health in Georgia

This paper discusses the public health situation in Georgia. In 1991 Georgia became an independent republic following the collapse of the Soviet Union. The armed conflict with Russia in 2008 and political unrest in recent years has presented the Georgian population and politicians with a demanding situation. As part of the WHO European Region, the Commonwealth of Independent States (CIS) including Georgia is on the unfortunate side of a European health divide, with low male life expectancy and high under-five mortality. There is also a high degree of economic inequality in the population. We first look at the main players and the current strategies in public health work. Next we discuss this on the background of health promotion principles and recent international developments in knowledge and policy recommendations in the field of health promotion. Finally we point to some of the major public health challenges that Georgia faces. We conclude that the Georgian focus on reducing risk behaviours and improving access to quality health care is worthy of praise, but that this is not sufficient to solve the current public health challenges. Strategies for working across sectors with social determinants of health should be built into Georgian health thinking and policies. A health promotion work force should be developed. International developments such as the Commission on Social Determinants of Health (CSDH) report, the 'Health 2020' framework and the HP Core Competencies project all provide useful input to future development of healthy public policies in Georgia.

A critical evaluation of the UK SunSmart campaign and its relevance to Black and minority ethnic communities

Skin cancer is the most common cancer in the United Kingdom and is rising to epidemic proportions. While the majority of skin cancers are treatable, malignant melanoma kills over 2,000 people in the United Kingdom each year, with all skin cancers killing a total of more than 2,500 people annually. SunSmart, the United Kingdom's major skin cancer public health initiative, was implemented to raise awareness about sun exposure and to promote sun safety behaviours. However, it has failed to curb the incidence and mortality rates. Furthermore, while Australia has the highest skin cancer incidence rates globally, the mortality rates are lower than those in the United Kingdom. There has also been a growing amount of evidence demonstrating ethnic disparities in skin cancer survival rates. Even though incidence rates of skin cancer among Black and minority ethnic (BME) groups are significantly lower, it is often diagnosed late, resulting in higher mortality rates. This, coupled with climate change and the proportion of BME groups expected to rise in the United Kingdom from 8% to 20% by 2051, raises public health concerns. This article aims to critically analyse the UK SunSmart campaign's success in addressing skin cancer in the population and in particular its relevance to BME communities. It also compares this approach with the Australian campaign. This article demonstrates that Australia's campaign has been more successful than the United Kingdom's due to their more comprehensive application of health promotion and public health principles.

Health Promotion in Ecuador: A Solution for a Failing System

In 2008, the newly written Ecuadorian Constitution guaranteed access to healthcare for all citizens. Consequently, a vast amount of resources have been directed toward rebuilding the public healthcare system, which was in shambles due to the effects of neoliberalism. Although national healthcare studies show positive outcomes, community-based research studies from an impoverished rural barrio in southern Ecuador indicate that the public healthcare system has been unable to address a health epidemic. Based on several years of fieldwork, we argue that the failure originates from the continued functioning of the biomedical model of healthcare as the dominant health discourse in Ecuador. The ensuing result has been the construction of health system governed by an “administrative state” that enforces health policies from the top-down and delivers “episodic” emergency-style care. Accordingly, we maintain that the Ministry of Health (MOH) should create a nationwide community-based health promoter program guided by the principles of health promotion.

Health lifestyles of pre-school children in Nordic countries: parents' perspectives

Holistic understanding of health is one of the key principles of health promotion indicating that the health status of individuals and populations is determined by a variety of environmental, economic, social and personal factors. Traditionally, research focus has been on school-aged children and school-based interventions and less on pre-school children and their families' engagement in promoting health in everyday life. The aim of the present study was to explore factors that parents of pre-school children in the Nordic countries experienced as influencing health lifestyles in their children's everyday lives. Semi-structured interviews were conducted with 25 parents of pre-school children in the five Nordic countries. Qualitative content analysis was used to analyse the data. The parents identified themselves as the primary shapers of their children's lifestyles and described influencing factors related to themselves as well as to their immediate surroundings and the larger society. Attaining a health lifestyle in everyday life of Nordic parents with pre-school children appeared to be all about the ‘management of time when attempting to live up to expectations’. Pre-school children's lifestyles are to a great extent intertwined with their parent's lifestyles and should be approached, both in research and practice, accordingly. Parents of pre-school children in the Nordic countries appear to be living their everyday lives straining to adapt to norms prevailing in society and may need encouragement and support in managing time in order to promote health lifestyles for themselves and their children.

Social Justice and the Urban Obesity Crisis: Implications for Social Work

Social Justice and the Urban Obesity Crisis: Implications for Social Work is written by Melvin Delgado in response to the need for such a work, which uniquely addresses obesity from a social justice perspective specific to the social work profession. This book brings context to what is often deemed a “public health crisis” by examining the roles of various social, economic, historical, policy, media, and cultural factors that influence its definition, magnitude, perception, intra- and interpersonal reality, and subsequent treatment. Delgado outlines six goals of this work: (1) offer a current analysis of the extent and outcomes of obesity in the United States; (2) bring attention to obesity among “marginalized communities of color” through the lens of social justice; (3) address social bases and corollaries for marginalized populations; (4) assess methodological confounds in quantifying obesity and related interventions; (5) recognize the efficacy of “community-based participatory health promotion principles and interventions” (p. 24); and (6) explore the role of the social work profession in shaping urban obesity intervention strategies. The far-reaching goals of Social Justice and the Urban Obesity Crisis are unified through the author's commitment not only to community-based perspectives, but also to democratic community-led intervention strategies well suited to divergent contextual influences that contribute to the complexity of the challenge at hand. Delgado's espousal of an asset model versus a medical or deficit model in addressing urban obesity is well aligned with the social justice paradigm and the social work profession and offers new avenues for change in the arena of health promotion.

‘Let other people do it…’: the role of emergency department nurses in health promotion

To explore emergency department nurses' roles in health promotion and contributing factors involved. In many healthcare systems, emergency departments are increasingly urged to play a crucial role in health promotion. Although much has been written about health promotion and nurses in acute care settings, less has focused on emergency departments. A qualitative design was used. In-depth semi-structured interviews were used with a convenient sample of 15 nurses in a Jordanian emergency department. Data were analysed using nvivo 9 (QSR International, Doncaster, Victoria, Australia). The analysis identified two themes. The first focused on nurses' roles in health promotion, comprising two categories: having no roles and 'let other people do it'. The second theme focused on the context and constraints of health promotion comprising fear of violence, the nature of healthcare service and patients' beliefs. The majority of nurses in emergency departments do not associate health promotion with their practice, hold some negative attitudes and devote more time to clinical tasks than health promotion, which is seen as a second priority. The ideology of medicalised tasks has penetrated deeply into the core principles of health promotion, and thus, nurses' roles and potential in this area are questioned. Decision-makers and nurses within the hospital are urged to address the constraints identified in this study and debate them further. Failure to do so may lead to emergency nursing not being optimally achieved, with the absence of sustained and concerted health promotion work matching patients' cultural needs and sensitivities.

The correlates of stress, coping styles and psychiatric morbidity in the first year of medical education at a Nigerian University

This study was prompted by the heightened concerns about the stress inherent in medical education evident from the incessant requests for suspension of studies due to psychological problems. The objectives of the study were to: (i) survey the students for possible psychological problems at admission, and follow them up till exit for possible changes in morbidity, and (ii) ascertain possible risk factors, and coping strategies. This is a preliminary 2-stage cross-sectional report, which is part of a longitudinal survey. It involves first year medical students of the College of Health Sciences of University of Ilorin between March and April, 2011. Questionnaires used included socio demographic, sources of stress, the general health questionnaire-12 (GHQ-12), Maslach's burnout inventory (MBI), and Brief COPE. Data were analysed using SPSS version 15 at 5% significance level. Chi-square, frequency distributions, Pearson's correlation, Odd ratios, and Confidence Intervals were calculated to determine the levels of risk. 79 students returned completed questionnaires. 12 (15.2%) were ghq-12 cases (i.e., scored ≥ 3). Students who had morbidity were 9 times at risk of being stressed consequent upon 'competing with their peers' and 4 times at risk due to 'inadequate learning materials'. Morbidity was significantly more likely to engender use of 'religion', 4 times less likely to engender use of 'positive reframing' with a trend in the use of 'self blame' as coping strategies. Aside from psychosocial/personal issues in this cohort, academic demand was an additional source of psychological problems thereby causing those who had morbidity to utilize 'religion' and 'positive reframing' to cope. There is therefore an apparent need to incorporate the principle of mental health promotion in medical education.

P2.026 Audit of Adherence to UK National Guideline For Management of Epididymo-Orchitis

BackgroundThe UK guideline for epididymo-orchitis management makes recommendations about appropriate diagnostic tests, treatment regimes and health promotion principles. This audit compares our clinic’s performance with reference to these guidelines.MethodsCase notes...

Percepção e prática da promoção da saúde na estratégia saúde da família em um centro de saúde em São Paulo, Brasil

In Brazil, Primary Health Care has in the Family Health Strategy (FHS) a proposal for the reorganization of health services; to this end, it focuses on a paradigm shift based on health promotion principles. Considering this complex scenario of transformation, this study aimed to explore and discuss health staff understanding and their difficulties in carrying out their health related activities in accordance with the theoretical construct of health promotion. This case study is a descriptive and exploratory research, with a qualitative approach, using the thematic analysis technique. The participants in this research were the health professionals who compose the family health teams of a Health Center in the far eastern section of the city of Sao Paulo. After analyzing the data, it was found that the concepts and practices related to health promotion seem to be linked to the narrower concept of disease prevention. Regarding work organization, health professionals pointed out their activities as structured around closed packages of risk groups, aiming mainly at prevention and cure, highlighting health promotion as occupying a second role. In conclusion, transversal powerful public policies are necessary for transforming the professional background and organization of services from the perspective of health promotion.

Problemas ambientais, sustentabilidade e a pesquisa em enfermagem

Problemas ambientais, sustentabilidade e a pesquisa em enfermagem

Reducing social inequities in health through settings-related interventions — a conceptual framework

The creation of supportive environments for health is a basic action principle of health promotion, and equity is a core value. A settings approach offers an opportunity to bridge these two, with its focus on the interplay between individual, environmental and social determinants of health. We conducted a scoping review of the literature on theoretical bases and practical applications of the settings approach. Interventions targeting social inequities in health through action on various settings were analyzed to establish what is done in health equity research and action as it relates to settings. Four elements emerged as central to an equity-focused settings approach: a focus on social determinants of health, addressing the needs of marginalized groups, effecting change in a setting's structure, and involving stakeholders. Each came with related challenges. To offer potential solutions to these challenges we developed a conceptual framework that integrates theoretical and methodological approaches, along with six core guiding principles, into a 'settings praxis'. Reducing social inequities in health through the creation of supportive environments requires the application of the settings approach in an innovative way. The proposed conceptual framework can serve as a guide to do so, and help develop, implement and evaluate equity-focused settings-related interventions.

Health Promotion Thinking, Interpretation and Implementation in Iran: Capacities, and the Way Forward

Copyright © 2013, Health Promotion Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Reviewing the history of public health in the past 60 years indicates evidence of significant changes and adaptive developmental shifts in public health focuses and approaches to health. Our collective understanding about health and its determinants has changed from non-scientific approaches to the scientific approaches including medical, psychological, ecological, social and more recently systems approaches (1). The concept of “health promotion” coined in Ottawa Charter in 1986 (2), was a revolutionary shift from reductionist individualistic perspective to holistic population perspective to health which values the role of the context and its political, economic, environmental and social dimensions. The Ottawa charter advocates for five key actions including building healthy policies, creating supportive environments , strengthening community actions , developing individual skills and re-orienting health systems. Since emergence of health promotion approach to health the required capacity for implementing health promotion values, principles and concepts were developed in many countries Especially developed countries. Health promotion capacity can include essential knowledge, skills, commitment, structures, systems and leadership (3) policies, institutions, programs and practices (4) to enable effective health promotion and mainstreaming health promotion for strengthening national health systems and promote population health. However, these complementary and adaptive changes did not happen in all regions and countries in a similar ways. While the uptake of health promotion in developed countries led to significant change in their capacities such as policy, infrastructure and practice and hence improved their population health, many developing countries lagged behind. Although the dialogue of health promotion has been diffused in many developing countries such as Iran, the research shows differences in the understanding of key concepts of health promotion and lack of a functional health promotion infrastructure in the majority of developing countries around the world (5).

Methodology for the evaluation of the Stephanie Alexander Kitchen Garden program

Community and school cooking and gardening programs have recently increased internationally. However, despite promising indications, there is limited evidence of their effectiveness. This paper presents the evaluation framework and methods negotiated and developed to meet the information needs of all stakeholders for the Stephanie Alexander Kitchen Garden (SAKG) program, a combined cooking and gardening program implemented in selectively funded primary schools across Australia. The evaluation used multiple aligned theoretical frameworks and models, including a public health ecological approach, principles of effective health promotion and models of experiential learning. The evaluation is a non-randomised comparison of six schools receiving the program (intervention) and six comparison schools (all government-funded primary schools) in urban and rural areas of Victoria, Australia. A mixed-methods approach was used, relying on qualitative measures to understand changes in school cultures and the experiential impacts on children, families, teachers, parents and volunteers, and quantitative measures at baseline and 1 year follow up to provide supporting information regarding patterns of change. The evaluation study design addressed the limitations of many existing evaluation studies of cooking or garden programs. The multistrand approach to the mixed methodology maintained the rigour of the respective methods and provided an opportunity to explore complexity in the findings. Limited sensitivity of some of the quantitative measures was identified, as well as the potential for bias in the coding of the open-ended questions. The SAKG evaluation methodology will address the need for appropriate evaluation approaches for school-based kitchen garden programs. It demonstrates the feasibility of a meaningful, comprehensive evaluation of school-based programs and also demonstrates the central role qualitative methods can have in a mixed-method evaluation. So what? This paper contributes to debate about appropriate evaluation approaches to meet the information needs of all stakeholders and will support the sharing of measures and potential comparisons between program outcomes for comparable population groups and settings.

Health communication in primary health care -A case study of ICT development for health promotion

BackgroundDeveloping Information and Communication Technology (ICT) supported health communication in PHC could contribute to increased health literacy and empowerment, which are foundations for enabling people to increase control over their health, as a way to reduce increasing lifestyle related ill health. However, to increase the likelihood of success of implementing ICT supported health communication, it is essential to conduct a detailed analysis of the setting and context prior to the intervention. The aim of this study was to gain a better understanding of health communication for health promotion in PHC with emphasis on the implications for a planned ICT supported interactive health channel.MethodsA qualitative case study, with a multi-methods approach was applied. Field notes, document study and focus groups were used for data collection. Data was then analyzed using qualitative content analysis.ResultsHealth communication is an integral part of health promotion practice in PHC in this case study. However, there was a lack of consensus among health professionals on what a health promotion approach was, causing discrepancy in approaches and practices of health communication. Two themes emerged from the data analysis: Communicating health and environment for health communication. The themes represented individual and organizational factors that affected health communication practice in PHC and thus need to be taken into consideration in the development of the planned health channel.ConclusionsHealth communication practiced in PHC is individual based, preventive and reactive in nature, as opposed to population based, promotive and proactive in line with a health promotion approach. The most significant challenge in developing an ICT supported health communication channel for health promotion identified in this study, is profiling a health promotion approach in PHC. Addressing health promotion values and principles in the design of ICT supported health communication channel could facilitate health communication for promoting health, i.e. ‘health promoting communication’.

Effects of an Advanced Practice Nurse In‐Home Health Consultation Program for Community‐Dwelling Persons Aged 80 and Older

ObjectivesTo evaluate the effects of an advanced practice nurse (APN) in-home health consultation program (HCP) on quality of life, health indicators (falls, acute events), and healthcare utilization.DesignRandomized clinical trial.SettingOne urban area in the German-speaking part of Switzerland.ParticipantsFour hundred sixty-one community-dwelling individuals aged 80 and older (mean age 85, 72.7% female, all Caucasian) participated in the intervention (n = 231) and control (n = 230) groups.InterventionAfter a comprehensive geriatric assessment, participants were randomly assigned to the 9-month HCP with four in-home visits and three phone calls from APNs or to a control group with standard care with no intervention.MeasurementsThe primary outcome was quality of life at 3, 6, and 9 months. Secondary outcomes were incidence of falls, acute events due to health problems, and healthcare utilization measured for 3-month periods at 3, 6, and 9 months.ResultsThe intervention and control groups did not differ significantly on any dimension of the World Health Organization Quality of Life questionnaire but differed significantly over 9 months in self-reported acute events (116 vs 168, relative risk (RR) = 0.70, P = .001), falls (74 vs 101, RR = 0.71, P = .003), consequences of falls (63.1% vs 78.7%, chi-square = 7.39, P = .007), and hospitalizations (47 vs 68, RR = .70, P = .03).ConclusionThe in-home HCP provided by APNs and guided by the principles of health promotion, empowerment, partnership, and family-centeredness, can be effective in reducing adverse health outcomes such as falls, acute events, and hospitalizations.

How Can Both the Intervention and Its Evaluation Fulfill Health Promotion Principles? An Example From a Professional Development Program

The emergence over the past 20 years of health promotion discourse poses a specific challenge to public health professionals, who must come to terms with new roles and new intervention strategies. Professional development is, among other things, a lever for action to be emphasized in order to meet these challenges. To respond to the specific training needs of public health professionals, a team from the Direction de santé publique de Montréal (Montreal Public Health Department) in Quebec, Canada, established in 2009 the Health Promotion Laboratory, an innovative professional development project. An evaluative component, which supports the project's implementation by providing feedback, is also integrated into the project. This article seeks to demonstrate that it is possible to integrate the basic principles of health promotion into a professional development program and its evaluation. To this end, it presents an analytical reading of both the intervention and its evaluation component in light of the cardinal principles in this field. Initiatives such as the Health Promotion Laboratory and its evaluation are essential to consolidate the foundations of professional development and its assessment by concretely integrating health promotion discourse into these practices.

Opportunities to Enhance Prevention-Related Competencies in Graduate Medical Education in Psychiatry: A Position Statement of the Prevention Committee of the Group for the Advancement of Psychiatry

The field of psychiatry has adopted a renewed emphasis on applying a public health approach to mental health care. A fundamental principle in public health is to focus on the prevention of illnesses and the promotion of well-being. Psychiatry has long stressed the importance of prevention and mental health promotion with every significant stride that is made in research and policy arenas, particularly in the areas of national and international policy, but also in everyday psychiatric practice (1). The recent passage of the Patient Protection and Affordable Care Act has the potential to attract even greater attention to issues of prevention and mental health promotion in psychiatry and throughout medicine. However, even with an increased understanding of the importance of these interventions, few psychiatrists are properly equipped with a foundation of knowledge in the prevention of mental illnesses and the promotion of mental health (2). Currently, the timing is ideal for reframing the importance of wellness and prevention in residency training programs, preparing psychiatrists with the necessary skills to practice prevention- and health promotion-minded psychiatry. The Group for the Advancement of Psychiatry (GAP) Prevention Committee recommends expanded training in the prevention of mental illnesses and the promotion of mental health in psychiatry residency training through three specific interventions: 1) creating a patient care-based preventive psychiatry rotation; 2) adding didactic curricula that address specific topics in mental illness prevention and mental health promotion; and 3) providing specialized training in systems-based practice aspects of mental health promotion and mental illness prevention. Psychiatrists can effectively highlight prevention of mental disorders and promotion of mental wellness by serving as advocates, technical advisors, program directors, researchers, and preventive care providers in various settings (3). Residency training is an ideal starting point to move forward in the dissemination of prevention and mental health promotion principles. The Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for graduate medical education in psychiatry set the training standards by which all U.S. psychiatrists become proficient practitioners. The Council clearly defines the specialty of psychiatry as “a medical specialty focused on the prevention, diagnosis, and treatment of mental, addictive, and emotional disorders” (4). As the Prevention Committee of GAP, we are indeed pleased and encouraged to see that the specialty is defined first and foremost by an emphasis on prevention. However, we believe that even more specific, well-defined competencies will increase the relevant knowledge and experience base for all psychiatrists. Among the six ACGME competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice) prevention is mentioned in two competency areas. There is a focus on prevention when describing components of medical knowledge within the didactic curriculum, and an expectation that residents “advocate for the promotion of mental health and the prevention of disease” from a systems-based practice perspective (4). We believe that additional competency domains would benefit from more clearly defined prevention- and promotion-related training goals. In particular, we will outline our position on the expansion of training (and the expansion of actual program requirements) with regard to three competency domains: patient care, medical knowledge, and systems-based practice.

Abordagens ecossistêmica e comunicativa na implantação de agendas territorializadas de desenvolvimento sustentável e promoção da saúde

This paper analyzes the sustainability of ecosystemic and communicative approaches in terms of strategic planning for the implementation of territorial agendas that seek to integrate the principles of Sustainable Development and Health Promotion. It takes the Sustainable Development and Health Promotion project: Implementation of the Healthy Cities Agenda integrated with Agenda 21 in Traditional Communities of Protected Areas of the Bocaina Region" as a point of reference. It involves action-research that strives to contribute to the promotion of quality of life by means of the implementation of a participative strategic agenda and the promotion of mutual economic sustainability. The work seeks to build theoretical/practical bridges between the approaches and the methodologies and technologies used, assessing their consistency and effectiveness in relation to the principles of sustainable development and health promotion, especially in the empowerment of the local population and the broadening of the autonomy of the community.

Achievements of the Iranian family planning programmes 1956–2006

Family planning programmes initiated in the Islamic Republic of Iran from 1966 met with limited success. Following the 1986 census family planning was considered a priority and was supported by the country's leaders. Appropriate strategies based on the principles of health promotion led to an increase in the contraceptive prevalence rate among married women from 49.0% in 1989 to 73.8% in 2006. This paper reviews the family planning programmes in the Islamic Republic of Iran and their achievements during the last 4 decades and discusses the principles of health promotion and theories of behaviour change which may explain these achievements. Successful strategies included: creation of a supportive environment, reorientation of family planning services, expanding of coverage of family planning services, training skilled personnel, providing free contraceptives as well as vasectomy and tubectomy services, involvement of volunteers and nongovernmental organizations and promotion of male participation.

Moving from health education to health promotion

PurposeThis paper seeks to discuss the rationale of the newly reformed health education curriculum in Cyprus, which aspires to enable not only teachers, but also all the school personnel, to work from the perspective of health promotion. It is a curriculum which moves from the traditional approach of health education focusing on individual lifestyle/behaviour modification into approaches that recognise and tackle the determinants of health.Design/methodology/approachThe paper critically discusses the structure and the content of the learning objectives of this curriculum that encourages teachers to work in a health promoting way.FindingsThe central goal of this curriculum is to enable students and schools to act as health agents, addressing the structural determinants of health and promoting environmental changes. The optimum level for all topics of the curriculum is achieved through learning objectives, which concern three interconnected levels. These are: “investigating determinants of health”, “practising action competency skills for health” and “achieving changes in favour of health”. All levels are means as well as end products in terms of the curriculum objectives.Practical implicationsThe outcome of the development of the health education curriculum acts as a guide for school interventions, through a methodological framework, which encourages participants to identify and promote environmental changes that facilitate healthy choices. This is of significance to those working in the field of health promotion and who seek to establish a new language of health promotion that goes beyond the pervasive discourse of individual lifestyles.Social implicationsThe implementation of the particular health education curriculum will promote not only health in the school community but also in the local community. This is because a key principle which underlies the curriculum is the involvement of the students, school staff, family and community in everyday health promotion practice. It also promotes the development of partnerships among them.Originality/valueThis is an innovative curriculum for Cyprus, based on health promotion and health education principles, but at the same time taking in account the local socio‐cultural and political perspective. This curriculum may be applicable to other European countries.