Survey of health promotion organisational arrangements and levels of service for health promotion

This study was promoted by the Executive Committee of the Association of Directors of Public Health when faced with the need to examine the organisation of and quantify health promotion arrangements in the Health Districts of England and Wales, resulting from the concerns of many of the members of the Association. These concerns were based on the views that health promotion is a key purchasing function of the District Health Authorities and must be appropriately and effectively structured and adequately resourced if the requirements of The Health of The Nation are to be fulfilled.There are many aspects to health promotion work and the delivery of health promotion services which will need addressing in the new commissioning environment of the NHS. A need was recognised for up-to-date data about health promotion services to inform a necessary debate about future arrangements, since it appeared that organisational change was being driven by influences unconnected with the possibly most appropriate structure of health promotion departments and which relate to a contemporary view of health promotion. Reducing the size and cutting the cost of commissioning authorities was perceived as one of the most important influences. A postal questionnaire survey to all Health District and Regional Health Authorities in England and Wales was conducted covering questions about the present organisational arrangements and levels of service, and soliciting the opinions of those canvassed. A total of 185 District and Regional Health Authorities, effectively reduced to 171 because of mergers, was sent questionnaires, of which 141 were completed and returned, giving a response rate of 82.5%.Most Health Promotion Units are currently purchaser-only based or split betweenpurchaser and provider bases. The majority of Districts have an establishment for a Director of Health Promotion, who is likely to be based at the purchaser level, Most directors have support staff. The median staff level in this survey is 7 WTEs (whole-time equivalents), and the level for the population served is 2.74/100,000. A little over 50% of respondents felt that health promotion should be a split purchaser and provider function, and there is evidence that this opinion has changed in recent years. This reflects concern expressed in comments made by respondents about the practical problems inherent in the separation of the purchaser and provider elements of health promotion activities, resulting from the ostensible requirements of the purchaser/provider reorientation in the NHS. The survey provides a picture of the present organisational arrangements in health promotion across the country and forms a basis for discussion of future developments. It highlights the problems of integrating all health promotion functions under a single management umbrella, purchaser or provider, and of the perceived importance of ensuring an adequate health promotion structure at the commissioning level.     

An empirical model for school health promotion: the Western Australian school health project model

Models of school health promotion simplify and support the complexprocess of encouraging schools to adopt health promotion aspart of their organizational practice by outlining phases andareas that bear on adoption and scope of activity. Models providea value conceptual framework on which to base action and a standardagainst which to measure success. The Western Australian SchoolHealth (WASH) model is an empirically designed model that canassist both internal and external agents seeking to interestschools in developing comprehensive school health promotionprograms. The WASH Model schematically represents the main elementsof the WASH Project's process of initiating and developing healthpromotion with Western Australian schools. The model is basedon the project's practical implementation experience (1992–1995)as an external intervention with its own specific health promotionagenda, operating in a setting that requires a participativeapproach to maximize outcomes. The model draws on system theoryrelated to organizational change processes and on previous modelsof school health promotion. The WASH Project, which used thismodel in its interaction with schools, was able to demonstratechange in the level of health promotion activity and structuralsupport in participating schools. Accordingly, the model providesa tested framework on which to base approaches and activityfor school health promotion initiation, development and continuity.     

上海市中小学校卫生保健教师专业素质及其发展状况评估

  目的  评估上海市中小学校卫生保健教师专业素质的自我觉察及其发展状况,为专业能力建设及未来的专业化发展提供依据。  方法  使用自主研制的学校卫生保健教师专业素质调研问卷,对上海市1 722名中小学一线卫生保健教师进行问卷调查。  结果  中小学卫生保健教师以本科学历(65.6%)、初级职称(43.4%)为主,专职教师占比66.5%,有69.8%的教师承担健康教育课程,7.7%排进正式课表;“师德修养”和“学校公共卫生防控”2个专业维度得分较高(4.68±0.43,4.55±0.47)分,学校健康教育所属2个专业维度(健康教育实施与改进、健康教育基本素养)得分最低且数据离散度较高[(3.96±0.66,3.91±0.65)分];卫生保健岗位工作年限6~14年组素质自评均值几乎在所有维度上略占优势;≥15年组素质得分在总体和师德修养、意外事件紧急处置2个维度上低于6~14年组,在特定健康问题应对维度上低于1~5年组(P值均 < 0.05)。  结论  中小学卫生保健教师入职门槛有待提高;教师的师德修养、学校公共卫生防控知识能力较好;健康教育知识能力整体储备不足,教师个体间出现明显分化。应制订卫生保健教师准入资格和专业标准,引领教师不断学习提升;同时从政策层面畅通卫生保健教师专业职务晋升途径。     

上海市中小学卫生保健教师专业化发展研究

目的了解中小学卫生保健教师专业化发展现状,为卫生保健人才的培养提出建议。方法采用定量调查和定性访谈相结合的方式,对上海市16个区的126名卫生保健教师进行问卷调查,并对6所学校的卫生保健教师进行访谈。结果调查的126名卫生保健教师,来自小学54所、初中30所、高中14所、九年一贯制学校22所,完全中学6所。卫生保健教师配备达标率为44.44%,获得卫生资格证的占41.27%;不同学段教师获得卫生资格证的情况差异有统计学意义(χ~2=16.591,P<0.01);获得教师资格证的占54.76%,不同学段教师获得教师资格证的情况差异有统计学意义(χ~2=16.988,P<0.01);具有教师职称的占41.26%,具有医生或护士职称的占58.74%,不同学段教师职称类型差异无统计学意义(χ~2=7.720,P>0.05);副高级职称占1.59%,中级职称占32.54%,初级职称占65.87%,不同学段教师职称差异无统计学意义(χ~2=2.425,P>0.05)。结论上海市中小学卫生保健教师队伍专业化程度较低。应强化地方、高校教育行政部门和中小学的三方联动,打造三位一体的教师专业发展联盟,促进卫生保健教师的专业化发展。     

Design principles for data- and change-oriented organisational analysis in workplace health promotion

This article focuses on organizational analysis in workplace health promotion (WHP) projects. It shows how this analysis can be designed such that it provides rational data relevant to the further context-specific and goal-oriented planning of WHP and equally supports individual and organizational change processes implied by WHP. Design principles for organizational analysis were developed on the basis of a narrative review of the guiding principles of WHP interventions and organizational change as well as the scientific principles of data collection. Further, the practical experience of WHP consultants who routinely conduct organizational analysis was considered. This resulted in a framework with data-oriented and change-oriented design principles, addressing the following elements of organizational analysis in WHP: planning the overall procedure, data content, data-collection methods and information processing. Overall, the data-oriented design principles aim to produce valid, reliable and representative data, whereas the change-oriented design principles aim to promote motivation, coherence and a capacity for self-analysis. We expect that the simultaneous consideration of data- and change-oriented design principles for organizational analysis will strongly support the WHP process. We finally illustrate the applicability of the design principles to health promotion within a WHP case study.     

Evidence-based health promotion programs for schools and communities

Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education to prevent health problems in the following areas: unintentional injury; violence; suicide; tobacco use and addiction; alcohol or other drug use; unintended pregnancy, HIV/AIDS, and sexually transmitted infections (STI); unhealthy dietary patterns; and inadequate physical activity. These specific goals are part of the efforts of Healthy People 2020 to increase the proportion of elementary, middle, and senior high schools that have health education goals or objectives that address the knowledge and skills articulated in the National Health Education Standards. A focus on Pre-K through 12 health education is a prerequisite for the implementation of a coordinated, seamless approach to health education as advocated by the Healthy People Curriculum Task Force and incorporated into the Education for Health framework. To help accomplish these goals, this article views the role of education as part of the broader socioecologic model of health. A comprehensive literature review was undertaken to identify evidence-based, peer-reviewed programs, strategies, and resources. The results of this review are presented organized as sexual health, mental and emotional health, injury prevention, tobacco and substance abuse, and exercise and healthy eating. Evidence-based implementation strategies, often considered the missing link, are recommended to help achieve the Healthy People 2020 objective of increasing the prevalence of comprehensive school health education programs designed to reduce health risks for children.     

中国高校全科医学专业师资现况分析

目的 了解中国高等医学院校全科医学专业师资基本状况,为进一步促进高校在本科生中开展全科医学教育提供科学依据.方法 采用自编问卷调查法,于2009年3月对全国51所高等医学院校进行全科医学教学师资状况调查,采用SPSS 13.0软件进行统计分析.结果 51所院校中共有全科医学专业师资201名,平均年龄42.6岁,其中东部省市男性师资比例最高,占57.1%;西部省市女性比例最高,占61.2%;但东、中、西部3地区全科医学专业师资性别、年龄构成上差异无统计学意义;所学专业中临床专业最多,占38.3%;全科医学专业最少,占4.0%;取得博士学位、硕士学位、学士学位的分别占18.4%,44.8%和35.3%;西部地区全科医学专业师资授课年限多数为≤4年,东部地区授课年限多数>6年.结论 应进一步规范并稳定高校全科医学专业师资队伍,明确全科医学教学任务,建立健全全科医学专业师资准入、评价和考核制度.     

Health-promoting schools: an opportunity for oral health promotion

Schools provide an important setting for promoting health, as they reach over 1 billion children worldwide and, through them, the school staff, families and the community as a whole. Health promotion messages can be reinforced throughout the most influential stages of children's lives, enabling them to develop lifelong sustainable attitudes and skills. Poor oral health can have a detrimental effect on children's quality of life, their performance at school and their success in later life. This paper examines the global need for promoting oral health through schools. The WHO Global School Health Initiative and the potential for setting up oral health programmes in schools using the health-promoting school framework are discussed. The challenges faced in promoting oral health in schools in both developed and developing countries are highlighted. The importance of using a validated framework and appropriate methodologies for the evaluation of school oral health projects is emphasized.     

Focus points for school health promotion improvements in Dutch primary schools

To enable improvements in school health promotion, this paper examines associations between the number of health-promotion issues addressed by primary school teachers in the Netherlands and factors thought to influence this behavior. The main factors studied are context characteristics and constructs of attitude, social influence, self-efficacy (SE) and perceived barriers. A total of 180 primary school teachers teaching 9- to 12-year olds (Grades 6, 7 and 8) participated in a cross-sectional survey. The results show that it is possible to differentiate between teachers addressing three or more health issues per year versus those who address fewer based on grade level (more health issues are addressed at higher grades), perceived disadvantages, SE and staff support. The latter seems to exert the greatest influence and may be one of the most promising focus points for improvements of school health promotion in the Netherlands.     

The institutional and professional benefits of housing athletic training education programs in schools of health professions

Accredited Athletic Training Education programs (ATEPs) are sponsored by over 350 universities and are housed in a variety of academic units ranging from schools of education to schools of health professions. There are advantages to all stakeholders housing ATEPs in schools of health professions. Formed in the 1960s, many of the early ATEPs were housed in schools of education, when most program faculty and staff were employed by athletics departments and the profession had a distinct curricular connection to coaching. Athletic training has since evolved to a health care profession, and its educational processes need to reflect this model. By housing ATEPs in units that educate other health care providers, many efficiencies and collaborative opportunities are introduced with a resulting overall improvement in the quality of the professional education of athletic trainers. The authors, directors of ATEPs housed in schools of health professions, provide examples of these benefits, which include opportunities for participation in interprofessional initiatives; opportunities for faculty development and collaborative teaching among like-minded faculty; improved mechanisms for scholarship, support and funding mechanisms; and economies of scale in terms of program delivery requirements.     

老年人健康促进自护模型概述

随着人口老龄化的加剧，人们开始日益关注老年人的健康问题，并且逐渐认识到自护活动有助于老年人发挥自身潜能，维持自身健康，使老年人度过一个自立的、多产的、有意义的老年生活。鉴于老年人在生理、心理各个方面具有其特殊性，美国学Mary Hobbs leenerts提出一个特别针对老年人健康促进的自护模型，以期指导老年人的健康促进工作。本将对此模型进行综述。     

广东推行基本职业卫生服务试点工作的实践

国际劳工组织(ILO)、世界卫生组织(WHO)和众多专业组织及劳动者组织一直强调对用人单位的职业卫生服务,以保障劳动者的健康和促进社会经济的可持续发展.2006年7月,卫生部在广东省深圳市宝安区和江门市新会区等全国19个县、区开展基本职业卫生服务(BOHS)试点工作.通过3年的工作实践与探索,取得了一定成效.     

The future of health promotion in schools goes through the strengthening of teacher training at a global level

Schools are considered to be settings for both health education and health promotion. But the core business of schools is actually focused on educational outcomes, not reducing health problems. In most countries, schools give low priority to health promotion, and school staffs, mainly teachers, are not aware of their role in health promotion. Studies show that teachers who have received health promotion training tend to be involved more frequently in health promotion projects and have a more comprehensive approach to health education. Pre-service and in-service staff training is then a main challenge. This is the reason why we have launched an initiative to join international forces to strengthen and advocate for teacher training in health promotion. The main goals are to develop research, affirm and reinforce the work done in teacher training in health promotion, support the institutes/colleges/universities in the provision of pre-service and in-service teacher training and stimulate international partnership work.