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PubMed2004

[Health promotion and the epistemological sensitivity of 'community' as a category].

A discussion on the scope of "community" as a category in health promotion by means of its "epistemological sensitivity"--a reasoning tool based upon the epidemiological concept of "sensitivity", adjusted to the epistemological field--was carried out. A brief review of promotional health topics and a short description of the sociological usage of "community" according to Tönnies were performed. Issues regarding difficulties of defining contemporary communities are considered. Health promotion's leading approaches do not pay enough attention to crucial sociological concerns and philosophical standpoints. As a result, these approaches suffer from deep theoretical strain that weaken their premises and make corresponding interventions' results rather unsatisfactory.

Health Promotion↗

PubMed1988

Trends in health concepts and health promotion: a discussion paper.

Much misunderstanding and confusion exist about the meaning and nature of activities in health promotion. This article examines how our evolving beliefs and concepts about health have led to a new public health, namely health promotion. Health promotion is operationalized using Achieving Health for All: A Framework for Health Promotion.

Canada↗

PubMed2001

Setting standards in the evaluation of community-based health promotion programmes--a unifying approach.

Community-based health promotion often emphasizes elements of empowerment, participation, multidisciplinary collaboration, capacity building, equity and sustainable development. Such an emphasis may be viewed as being in opposition to equally powerful notions of evidence-based decision making and accountability, and with funders' and government decision-makers' preoccupation with measuring outcomes. These tensions may be fuelled when community practitioners and lay participants feel evaluations are imposed upon them in a manner that fails to appreciate the uniqueness of their community, its programme, and practitioners' skills and experience. This paper attempts to provide an approach that depicts evaluation as being mutually beneficial to both funders/government and practitioners. First, a values stance for health promotion, termed a 'salutogenic' orientation, is proposed as a foundation for the evaluation of community-based health promotion. Secondly, we discuss possible objects of interest, the first component of an evaluation. We then discuss the spirit of the times and its implications for community-based health promotion. Finally, we address the key question of setting standards. A typology of standards is presented. Arbitrary, experiential and utility standards are based on perceived needs and priorities of practitioners, lay participants or professional decision-makers. Historical, scientific and normative standards are driven by empirical, objective data. Propriety and feasibility standards are those wherein the primary concern is for consideration of resources, policies, legislation and administrative factors. The 'model' standards approach is presented as an exemplar of a combined approach that incorporates elements of each of the other standards. We argue that the 'optimal' standard for community-based health promotion depends on the setting and the circumstances. There is no 'magic bullet', 'one-size-fits-all' or 'best' standard. Further, we argue that standards should be set from an inclusive, salutogenic orientation. This approach offers a means of creating a situation in which policy-makers and funders are more supportive of evaluation designs that fit with community realities, and community stakeholders are more capable and consistent in rigorously evaluating community-based health promotion programmes and policies.

Canada↗

PubMed1989

Oral health promotion at worksites.

Many workplace-based health promotion programmes have been reported but only a few include or focus specifically on oral health. Although certain obstacles to oral health promotion in the workplace exist from the management side, from the dental profession and from the employees, these seem to be of a scale that can easily be overcome: moreover, numerous potential benefits exist. From the employer's point of view, the main arguments in favour are reduced health care costs, increased productivity and reduced absenteeism. The benefits to the dental profession are possible increases in utilization of services and less restraint from fee payment structures and physical environments. The immediate benefit to the employees is easy access to dental services. In addition, work-related dental hazards can be compensated for or prevented and screening activities can be more easily organized. The literature is at present sparse and there are few guidelines to actual strategies for effective oral health promotion. However, elements of strategies that have been successful in various geographical and economic environments include: active involvement of the work force, the use of dental auxiliaries, voluntary daily mouthrinsing, screening activities, use of mass media, oral hygiene instruction and prophylaxis and paraprofessional training. It is recommended that future research concentrates on these elements to build up a meaningful and relevant data base upon which effective oral health promotion programmes can be formulated.

Health Education, Dental↗

PubMed2000

Health promotion and senior women with limited incomes.

Health promotion is increasingly being recognized as making an important contribution to the well-being of Canada's seniors. Most research relating to this topic, however, has focused on middle-income senior men and women. An exploratory study using ethnographic methods was conducted to explore and describe the health promotion experience of senior women living on limited incomes. Interviews with a total of 11 urban senior women living on limited incomes were analyzed. A major finding of this study was that the women utilized a wide variety of "ways of living" that are presented in the model, Health Promotion as Self Nurturance. Health promotion was perceived to be influenced by living on a limited income by most participants; however, 3 of the participants believed that their health status and income level were unrelated. Findings are discussed and implications for community health nurses are offered.

Aged↗

PubMed2005

Recruitment of religious organisations into a community-based health promotion programme.

Programmes concerned with health promotion activities frequently rely on community organisations to deliver health behaviour change interventions. This paper presents data on the recruitment of religious organisations (ROs) into a research project focused on dietary change. The authors contacted the membership list of a local multi-denominational religious umbrella organisation by mail. The recruitment process consisted of a screening survey followed by an informational meeting with RO representatives, with additional meetings as necessary. The ROs were surveyed by telephone, and the initial and follow-up meetings were held at a location convenient to the RO representatives, often the RO's building. For this paper, the unit of analysis is the RO. The ROs approached during the recruitment process were of a variety of faiths and denominations. All were located within the metropolitan area of Seattle, WA, USA. The screening survey was used to determine RO eligibility, and collect further information on the RO and its membership. The survey included questions adapted from previous RO surveys and questions developed by the project team. The recruitment strategy yielded a 26% enrollment rate of eligible ROs. In comparison to eligible ROs, those that did not meet the eligibility criteria were less stable, smaller and had a membership that was less white, less college-educated and more working class. The size of the RO and the number of years that the religious leader had been with the RO were the strongest predictors of the RO's interest in participating in the project. These data will be helpful in recruiting community organisations into health promotion programmes.

Adolescent↗

PubMed1989

Health promotion in the medical curriculum.

It has been argued that health promotion should be included in the medical curriculum, if medical education is to match the needs and health goals of communities. In spite of the medical profession's awareness of the importance of health promotion, few universities in the UK have introduced a substantive course on the subject. This paper describes the teaching of health promotion in Nottingham Medical School. It identifies the aims and objectives of the course which are amongst others to develop an understanding of: the factors which influence the perception and experience of health and illness; the concepts of health promotion and health education; the scientific basis of health promotion; the relative effectiveness of approaches used; the measurement of health status and health behaviour; and health policy and planning. An innovative element of the teaching involves a community project which gives students experience of health promotion in practice. Evaluation of the impact of the course suggests that students perceive it to be interesting, stimulating and enjoyable, whilst examination and continuous assessment indicate that it has also influenced students' knowledge and understanding of the subject.

Community Medicine↗

PubMed1997

Health promotion practices of women with multiple sclerosis.

OBJECTIVE: To explore the health promotion behaviors of women with multiple sclerosis (MS), a chronic, disabling disease affecting the central nervous system. DESIGN: Participants completed a battery of instruments measuring illness-related disability, health-promoting behaviors, and quality of life. Descriptive statistics were used to examine the frequency of various health promotion practices among women with MS. Participants were grouped according to clinical course and compared on frequency of health-promoting behaviors using multivariate analysis of variance. Path analysis was used to test the hypothesis that health-promoting behavior mediates the relation of illness severity to quality of life. PARTICIPANTS: Women with physician-diagnosed MS (n = 629) who were community-residing were recruited with the assistance of two chapters of the National MS Society. MAIN OUTCOME MEASURES: Health Promoting Lifestyle Profile II; Quality of Life Index-MS Version. RESULTS: Overall, these women scored lower on measures of physical activity (moderate effect size) and spiritual growth (small effect size) than the comparison "normative" sample. Women with benign sensory and relapsing-remitting MS were more likely than women with progressive MS to engage in physical activity and spiritual growth behaviors. Health-promoting behaviors mediated the relation of illness-related disability to quality of life. CONCLUSIONS: Findings highlight the impact of living with a chronic disabling condition on the frequency of health-promoting behaviors. Additional research is needed to identify factors that enhance both the initiation and maintenance of health promotion behaviors.

Adolescent↗

PubMed1996

Where needs and demands diverge: health promotion in primary care.

UNLABELLED: This study reviews Forth Valley Health Board's 'Be Better Hearted' coronary heart disease health promotion programme by analysis of data routinely collected between 1988 and 1993. Associations between socioeconomic deprivation, prevalence of risk factors, and attendance at health promotion clinics are of particular interest in relation to future health promotion strategy. METHOD: A study was made of computerised records of 20,053 baseline risk factor assessments in the primary care setting and 1,058 follow-up attendances. A method of classification by socioeconomic status was applied. RESULTS: Baseline data provided a profile of new attenders over time with regard to age, gender, risk factors and socioeconomic status but lack of follow-up information prevented evaluation of the outcome of the programme. There was a statistically significant association between prevalence of risk factors (such as smoking, obesity and lack of exercise) and deprivation. In the most affluent areas 19.0% of the target population participated in the programme; in deprived areas this fell to 10.7%. There was thus a failure to involve those most in need of health promotion. CONCLUSION: If equity in provision of health promotion is to be achieved, measures must be taken locally and nationally to reach deprived sections of the population. In this type of health promotion programme, baseline and follow-up information should be entered on computer at the clinical locus to enable monitoring of outcome. These conclusions are particularly relevant to the national arrangements for health promotion in primary care which were introduced in July 1993.

Adult↗

PubMed1993

Health promotion in rural settings. A nursing challenge.

Health promotion is an exciting and integral part of nursing's domain of practice. Since the days of Florence Nightingale, nursing has identified the importance of health promotion at a variety of levels. Rural community offer the nurse a unique setting for health-promotion programs and activities. A variety of low- or no-cost health promotion programs and support materials are available. These types of programs and activities can be very rewarding to nurses in rural communities.

Audiovisual Aids↗

PubMed2004

Sex education as health promotion: what does it take?

Health promotion should be evidence-based, needs driven, subject to evaluation, and ecological in perspective. How can this be achieved in the context of school-based sex education? Adopting new behaviors and giving up old habits involves common decision-making, planning, motivational control, and goal prioritization processes. Consequently, despite the particular nature of sexual behavior, models of cognitive change applied to other health-related behaviors also apply to the promotion of safer sex practice. Young people are less likely to have unprotected sexual intercourse if they have acquired a variety of social skills relevant to dealing with romantic and sexual relationships. Many of these social skills and the methods employed to facilitate their development are also important to the promotion of other health behaviors. However, teaching social skills relevant to sexual behavior in classroom settings requires specialist expertise both in program design and in delivery by teachers or facilitators. Theory- and evidence-based programs designed to promote such skills and modified on the basis of effectiveness evaluations are most likely to have an impact on the rate of pregnancies and sexually transmitted infections among young people. Yet, such programs may not be used in schools because of policy and cultural constraints. When this is the case, optimally effective health promotion cannot be delivered. Health promoters should acknowledge these challenges and facilitate the adoption and implementation of effective sexual health promotion programs by targeting communities and legislators.

Adolescent↗

PubMed2006

Opinions of ageing workers on relative importance of health promotion.

This study describes individual, workplace and occupational health-promoting factors, and their impacts for worker's health from the perspective of ageing Finnish workers. The pretested questionnaire was sent to 150 ageing workers, of whom 93 returned the form. Statistical analyses were performed using frequencies, means, Mann-Whitney U-test and Krushkal-Wallis test. Over 90% of respondents stated that health habits, individual arrangements in the workplace, good workplace atmosphere, access to health checks, counselling and nursing care all represented important factors for health promotion. Better health, work satisfaction and motivation of employees were the main factors impacting on health promotion. Ageing workers stated that health and safety organization and rehabilitation institutes were the most important copartners. Management must take a positive attitude towards ageing workers and make the necessary arrangements to support their well-being and this should be done in collaboration with occupational health professionals.

Aging↗

PubMed2003

Comprehensive approaches to school health promotion: how to achieve broader implementation?

The Health Promoting School (HPS) and Comprehensive School Health Program (CSHP) initiatives have been proposed as a means of going beyond some of the limitations associated with health promotion initiatives aimed at school-aged children. This involves moving beyond practices that rely mainly on classroom-based health education models, to a more comprehensive, integrated approach of health promotion that focuses both on child-youth attitudes and behaviors, and their environment. Despite the tremendous potential of these initiatives in terms of health and educational gains, only rarely are they actually put into practice. This article briefly reviews the features of these initiatives, as well as the extent of their implementation and current benefits. Against that backdrop, the authors identify some issues to consider and propose four conditions with a view to achieving broader practical application of these approaches. These issues, which are discussed from the standpoint of potential avenues of further study and courses of action, relate to the comprehensive, integrated nature of the intervention, the school/family/community partnership, political and financial support from policy makers, and, finally, evaluative research as a support to implementation.

Health Promotion↗

PubMed1986

Health promotion in primary medical care: problems and potential.

Problems related to health promotion in primary medical care are reviewed within the framework of five characteristics of current medical practice: physician attitudes and beliefs, the economic structure of medical care, the structure of the medical-care encounter, the state of the art of health promotion, and physician knowledge and skills. The potential for integrating health promotion activities into the primary medical-care environment is based on the principles of pediatrics, general internal medicine, family practice, and obstetrics/gynecology. In the primary-care setting, both the roles and the expectations of physicians and patients are conductive to health promotion activities. Twelve practice principles for the primary physician are discussed, touching on such issues as style of communication, recognition of the "teachable moment," utilization of the longitudinality of the physician-patient relationship, coordination of care, and causes of failure. Issues for the future are reviewed, including the need for restructuring fee schedules, pursuing the knowledge base required for effective health promotion, and integrating training in health promotion methods and techniques in medical school curricula. The complex interactions during the next decade of three trends related to health promotion are discussed as determinants of the role of primary care as a substrate for health promotion.

Attitude of Health Personnel↗

PubMedDate not supplied

An organizational perspective on worksite health promotion.

Worksite disease prevention and health promotion have developed into a field of endeavor that is accepted by a majority of employers in the United States and welcomed by many of their employees. This chapter examines the evolution of worksite health promotion and describes current worksite activities and their benefits. The authors also discuss several issues that must be addressed for the future.

Health Promotion↗

PubMed2000

Health promotion in the curricula and teaching of two polytechnics in Finland.

The purpose of this study was to examine the manifestation of health promotion in two Finnish health care and nursing polytechnic curricula for students starting their studies in August 1997. Another goal was to explore students' and their teachers' perceptions of which modules contained health promotion, as well as to find out which modules contained integrated health promotion. In this study, data and investigator triangulation were used. The data consisted of the curricula of two polytechnics of health care and of interviews with 20 student nurses and their teachers. The data were analysed using content analysis. Health promotion studies were integrated with other studies in the curriculum of the first polytechnic, whereas the second polytechnic had two separate health promotion modules. While most students were in favour of separate health promotion modules, teachers supported integrated modules. Students also reported that their teachers integrated health promotion in modules which were not named as such, for example, in language modules. The results represent a major challenge concerning the content of health promotion in the curricula and, also, the methods for teaching health promotion. More cooperation between teachers during the process of planning curricula is recommended.

Curriculum↗

PubMed1984

Health promotion in long-term care: a contradiction in terms?

While health promotion potentially could play a significant role in improving the health and quality of life of nursing home residents, several major changes must take place if this concept is to hold relevance for the elderly in the long-term care environment. First, interpretations of the concept of health promotion must be broadened to include a focus on macro- as well as micro-level change and on a diversity of target groups including, importantly, policy makers and providers. Second, the "youth bias" inherent in many conventional health promotion efforts must be overcome, so that goals such as decreasing functional dependence in the frail elderly are seen as legitimate and appropriate health promotion foci. Third, viable alternative to nursing home placements must be developed and adequately funded for the many frail elders who would be better served in less intense care environments. And fourth, the dependency producing nature of institutional long-term care must undergo major changes compatible with the goals of promoting individual autonomy and enhancing quality of life. Nutrition, drug use and misuse, mental health, and staff training and retention are four areas examined in a closer look at specific changes needed to create nursing homes amenable to health promotion. Such changes on the institutional level, coupled with a strong national commitment to nursing home reform, are in keeping with Green et al.'s broad definition of health promotion as encompassing a variety of interventions on multiple levels designed to facilitate behavioral changes conducive to health. It is within this larger context that health promotion is seen as holding considerable promise for improving the health and quality of life of the institutionalized elderly.

Aged↗

PubMed2001

Knowledge and attitudes of primary care nurses and midwives towards health promotion in rural South Africa.

This study was designed to study knowledge, attitudes and views about health promotion among nurse clinicians in rural South Africa. The sample included 90 nurse clinicians (73 primary health care nurses and 17 midwives) in the age range of 24 to 59 years (M age 38.4 yr., SD = 9.3) in the Northern Province. Results indicate that nurses (66.6%) had an inadequate knowledge score on health promotion in this sample. Higher knowledge scores on health promotion were not associated with age and years of experience. However, male nurses had significantly higher knowledge scores on health promotion than female nurses. The majority strongly supported the centrality of their role in health promotion acknowledging the time constraints involved. Better knowledge on health promotion was associated with more positive views on health promotion. More nurses had a satisfactory positive attitude towards health promotion (63.3%) than knowledge about health promotion (33.3%). Finally, the study found that compliance with health promotion was seen as a problem but health counselling was nevertheless seen as cost effective.

Adult↗