Quality in health promotion

Less health finance and the competitive contract culture areleading many health services to adopt quality methods to proveand improve their quality. Health promotion programmes facesimilar changes, but have not made great use of modern qualitymanagement methods. In part this has been because the definitionsand approaches to quality have not appeared to be relevant tohealth promotion. Practitioners need to consider which methodsand approaches are most suited to their programmes. This papershows that many quality ideas and methods are congruent withgood practice in health promotion, and may help to implementsuch practices more widely as well as to develop theory andpractice. There is a danger that inappropriate ways of defining, specifyingand assuring quality will be imposed on programmes. Practitionersneed to consider which methods and approaches are most suitedto their programmes. This paper seeks to stimulate debate aboutthe need to prove and improve quality in health promotion, andabout how best to do so. It considers definitions of quality,measurement, competing quality paradigms, quality in contractingand concepts of process and system in the context of healthpromotion programmes.     

Evaluation of a workplace cardiovascular health promotion programme in the Republic of Ireland

This paper describes a comprehensive evaluation of the organizational impact of a workplace health promotion programme, in the context of a framework devised by Nutbeam in 1998. The Happy Heart at Work programme, sponsored by the Irish Heart Foundation, has been in existence for 10 years and aims to promote a healthy lifestyle through specially devised modular materials. A postal census survey of 785 valid registered sites expressing any level of initial interest in the programme yielded a 40% response rate (n = 311). Of these, 194 (63%) were currently active and 114 were not. Active organizations were less likely to be Irish owned (54.5% versus 71.4%, p < 0.05), and more likely to operate in shifts (72.3% versus 51.1%, p < 0.05) or to have an occupational physician amongst the staff (36.9% versus 31%). Programme impact within active organizations, based on pre-defined Health Promoting Workplace parameters, was documented. There was agreement in the questionnaire responses that participating organizations promote a smoke-free environment (mean rating on five-point scale = 4.42), employee health and well-being (4.21) and good nutritional practice (4.11). Triangulation of research methods, including a telephone survey of gatekeepers from within organizations (n = 18), focus groups with participant employees (n = 42) and a review of the staff opinions of the facilitating organization on the programme, all showed strong concordance with respect to the strengths and weaknesses of Happy Heart at Work. The programme was felt to help improve employees' lifestyle habits and morale, as well as the company's public image. The main drawbacks of the programme were its relatively low profile, even in actively participating organizations, and the fact that it was not seen to be independently sustainable without intensive and ongoing support.     

Bureaucratic logic in new social movement clothing: the limits of health promotion research

This paper discusses theoretical, methodological and politicalproblems in the field of health promotion research. It arguesthat these problems result from a partial and contradictoryappropriation of the discourse of new social movements. Politically,the health promotion movement is largely confined within thestate, rather than the expression of a social movement againstthe state. The direction of health promotion research and policyis, therefore, caught in the bureaucratic logic of ‘trappedadministrators’, and results in contradictory emphaseson problems like the development of ‘health promotionindicators’, which show little result in informing a broaderbut coherent conceptualization of health, let alone in effectingchange in health policy and outcomes. Such political problemsreflect parallel confusions about theory and methodology. Theoretically, the field relies heavily on a critique of bio-medicalscience, but fails to move beyond a rhetorical outline of analternative to systematic arguments about what promotes health.In this regard, the literature on health promotion remains unawareof important conceptual developments in the social sciences,relies on imprecise specifications of major constructs likecommunity empowerment, and has no conception of the state. Methodologically,the literature is influenced by contradictory epistemologicaltendencies which reflect a positivist inspiration (as in thesearch for indicators) and an anti-positivist emphasis on agencyand social change through the collective action and the discursivereconstitution of social identity, value and meaning. In regardto these questions, this paper is critical of observers whosuggest that the way ahead is to embrace post-modern researchstrategies. Movement in this direction would tend to diffusean already desultory research practice and depoliticize socialstruggles for meaningful change. The paper ends by suggestingthat the field of health promotion needs a more serious engagementwith critical social theory to construct a rigorous conceptualizationof health and its social correlates and to develop a coherentresearch practice and political project.     

Strengthening the evidence base for health promotion

This paper describes the evidence debate from the many players currently attempting to define best practices in health promotion. Expert opinions on the purpose of collecting evidence range from those who view evidence as a western notion of little use in the developing world to those who choose to focus on opportunities to demonstrate the effectiveness of health promotion. There is also much disagreement on what constitutes evidence. Some view evidence as strict outcomes of randomized clinical trials (RCT) and others place greater value on other unpublished sources, not traditionally viewed as valuable information. A challenge for health promotion in the new century is to foster and develop high quality, widely recognized and acceptable standards for evidence-based evaluation.     

The search for theory in health behaviour and health promotion

Health promotion is often viewed as based in experience; theoryis seemingly at a more abstract level. The reasons for thisare many. This paper explores some theoretical perspectiveswhich are relevant to health promotion. In particular, it considersa collective approach to the making of theory and what the componentsof a health behaviour and health promotion theory might include.     

Methods to persuade higher management to invest in health promotion programmes in the workplace

This study was conducted to find effective methods to persuadehigher management to invest in workplace health promotion (WHP)programmes. The study included 639 occupational health professionalsselected from the directory of the Japan Society for OccupationalHealth. A questionnaire survey was mailed to health professionalsthroughout Japan in 1992, and all respondents were asked toidentify themselves. We received 242 replies, which constituteda response rate of 38%. Eighty-one per cent of the respondentshad attempted to persuade higher management to implement a WHPprogramme. Health professionals frequently presented their caseto higher management through a safety and health committee (SHC),and advice provided at the SHC was perceived to be the mosteffective method by occupational nurses (ONs) and safety andhealth supervisors (SHSs). This method was rated second by occupationalphysicians (OPs), who thought recommendations from OPs stipulatedby the Industrial Safety and Health Law to be most effective.Statistics on medical examinations constituted the data mostfrequently used to persuade higher management, followed by reportson worksite inspections and health care plans. Nearly 90% ofOPs and 80% of ONs and SHSs felt that the above methods werefairly successful.     

Developing methodologies for evaluating community-wide health promotion

There has been growing recognition that health promotion programswhich target whole communities are more likely to be effectivein changing health behaviour. However, studies evaluating theimpact of community-wide health promotion programs rarely useadequate methodology. Randomised control trials where multiplewhole communities are randomly assigned to control and interventiongroups are optimum if evaluators hope to validly attribute changesin health behaviour to the intervention. However, such trialspresent a number of difficulties including cost and feasibilitylimitations and the evolving nature of statistical techniques.This paper proposes applying a fairly well-accepted phased evaluationapproach to the evaluation of community participation programs,using three defined phases. Phase 1 consists of small-scalestudies to develop the measures and assess acceptability andfeasibility of the intervention; Phase 2 consists of studiesin a small number of communities designed to trial the interventionin the real world; Phase 3 studies use an appropriate numberof entire communities to provide valid evidence of efficacyof the intervention. It is suggested that criteria be resolvedto identify adequate studies at each stage and that advantagesand limitations of Phase 1 and 2 studies be clearly identified.The paper describes the major design, sampling and analysisconsiderations for a Phase 3 study.     

Evidence-based purchasing of health promotion: methodology for reviewing evidence

In recent years, greater emphasis has been placed on evidence-basedpractice by health care purchasers, managers and practitionersaround the world. This is seen as a means of delivering greaterbenefits to patients and populations within existing resources.Evidence-based practice requires accessible information in aform that is relevant to the problems decision-makers face.The process of evidence-based practice needs to be informedby the best available research evidence of the effectivenessof health-promoting interventions combined with good judgementas to the applicability of that evidence and the feasibilityof implementation in the local context. The nature of evidencewhich can be brought to bear on the decision-making processmay vary in both quality and reliability. In the field of healthpromotion, the nature of problems requiring solutions is complex.Commonly there are multiple variables affecting multiple healthoutcomes. In addition, there is limited available evidence forthe effectiveness of interventions and it is of variable quality.These factors pose problems for ensuring evidence-based healthpromotion. This article describes New Zealand research commissionedby one of four regional purchasers of health services. The purchaserrequired the development of a framework to prioritize interventionsin 22 health promotion areas identified as priorities by theMinister of Health. Our framework was used to consider a broadrange of different kinds of evidence, including scientific research,organizational capacity, socio-cultural factors and local community-basedknowledge related to the determinants of health. Making explicitthe nature of our framework and the evidence we considered,enabled our recommendations about the most appropriate interventionsto be as valid and reliable as possible. Our judgement is thatas for evidence-based medicine, evidence-based health promotionmust employ both quantitative and qualitative evidence, andthat the final judgement about purchasing of health promotioninitiatives is essentially subjective and political.     

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.     

山西省百姓生殖健康促进工程实施情况

目的 调查山西省百姓生殖健康促进工程实施情况.方法 2019年3-4月对山西省117个县(区)的妇幼保健院保健部负责人和计划生育协会组织负责人234人、妇幼保健院从事生殖健康服务工作人员702人、村计生服务员和乡镇计生专干1 170人开展问卷调查,对比项目县和非项目县开展生殖健康咨询服务的情况.结果 项目县妇幼保健院、...     

Finnish Healthy Village Study: health profile analysis for local health promotion

Finnish Healthy Village Study started in 1981 as an innovativelocal level health promotion project in a small Syvänniemivillage in North Savo, Middle-Eastern Finland. In 1986, healthprofile analysis was carried out in four villages in North Savo.Altogether, 793 people working age (20–64 years) participatedin the first health profile analysis. Low education level, lackof social support, strenuous work, fatty food and lack of physicalexercise were identified as social, nutritional and behaviouralrisk factors for health. One third of the males and femaleswere lacking a close friend with whom to share joys and sorrows.The lack of spouse was a real social problem for 22% of malesand 13% of females. Loneliness was a serious problem among youngmale farmers and elderly women (widows). Heavy food, rich inanimal fat and poor in fresh vegetables, was reflected by thehigh serum cholesterol concentration (mean 6.6 mmol/l) and lowplasma concentration of vitamin C (34.4 µmol/7 in malesand 51.2 µmol/l in females). Marked deficiency of vitaminC (<11.4 µmol/l) was found in 25% of males. The functionaland working capacity deteriorated rapidly with age. One or morelong-term diseases were found in 66% of people 50–64 yearsof age. The health profile analysis revealed the obvious needfor active health promotion of people of working age in villages.     

National opportunities for health promotion: the Canadian experience

Health promotion is a fundamental strategy to address the majorissues which confront health systems in developed and developingcountries alike. Chief amongst these issues are unhealthy environments,health inequities and non-communicable diseases. The infrastructuresfor health promotion include mechan isms for development andimplementation of health policy; policies and programs supportiveof community involvement in health promotion programs; reorientationof the health care system towards prevention; and research.Consensus building among key stakeholders from the public andprivate sectors is at the core of the policy development process.A New Perspective for the Health of Canadians (1974) and theWHO Ottawa Charter for Health Promotion (1987) have guided healthpromotion policy and program development at both the nationaland provincial levels, in Canada, a number of initiatives haveplaced into pra ctice the policy frameworks, among them: HealthyCommunities, the Canadian Heart Health initiative, integrationofpreven lion into clinical practice, and structures to supportresearch in health promotion.     

Occupational health promotion amongst cattle farmers in Zambia

One of the main activities of the Italian Animal Health Programme(IAHP) in the Republic of Zambia, a bilateral project betweenthe Ministry of Agriculture of the Zambian Government and theGeneral Directorate for Development Cooperation of the ItalianMinistry of Foreign Affairs, is the control of Malignant Theileriosisin Southern Province, through immersion of cattle in dip tankscontaining an acaricide. There are potentially important healthrisks to farm workers and the environment as a result of thisintervention and these are discussed. The control measures undertaken,with special reference to health education programmes, are described.     

A new approach to health promotion in Ontario

Ontario is attempting a radical change in the way it approacheshealth and health policy. Aninte, sectoral Premier's Councilon Health Strategy was formed in late 1987, comprising CabinetMinisters and representatives of the community. Council's workhas been much influenced by the Health for All Movement. Healthgoals have been officially adopted by the province, and somehave been converted to objectives and targets. The Council haspublished policy documents on health services, devolution ofservices to the local level, and healthy public policy. Somemomentum was lost during a change in government in 1990 andthe Council has now been replaced by a new Council with a broadermandate. There appears to be a good chance that the Council'swork will significantly affect the new government's policy.     

The importance of lay theorising for health promotion research and practice

The paper argues that, in the present state of the art, thereis a need for a much more flexible approach to theory buildingin health promotion. The development of the field has been paralleledby an appreciation of the importance of the social and culturalcontext in under- standing health and health behaviour. Thisargues both for a shift in methods and a shift in the theoreticaland philosophical approaches underpinning these methods. Principally,the need to bring back culture, and the failures of existingtheory to tap into the richness, complexity and diversity ofhuman experience, argue for a theorising which will reveal laystructures of thought underpinning everyday health-relevantbehaviour.     

Setting an ethical agenda for health promotion

The Bangkok Charter for Health Promotion in a Globalized Worldhas sparked lively dialogue. Welcomed by some as a Charter currentto the times, there are others who see it as an unneeded andtherefore unwelcome challenger to the Ottawa Charter for HealthPromotion. Intended or not, the Bangkok Charter seems to signala shift in discourse, from a social-ecological approach andan emphasis on individual and community capacity-building andempowerment, to an investment approach and an emphasis on globalization,macro-level factors and policy. Positively, the Bangkok Charterproclaims to build on Ottawa, and no one suggests it is meantto replace the Ottawa Charter outright. In concert with that,the dialogue today is not so much about the ascendancy of theone Charter over the other, but about the degree to which theBangkok Charter remains true to the ethic of the Ottawa Charter.It is welcome that the Ottawa and Bangkok Charters are the subjectof brisk dialogue about strategy and tactics in a rapidly changingworld, and about the foundational values of health promotion.Regarding the latter, we have unfinished work in constructingan ethic for health promotion, and the present dialogue mayinspire us to progress. Though we have the cornerstone of anethic for health promotion, in the Ottawa Charter and in otherprincipled documents that have followed, we have yet to buildsufficiently on the cornerstone; an ethic for practice has yetto be codified, and the same is true for research. Health promotionjournals, conferences and organizations can and should do moreto facilitate dialogue on ethics in health promotion, and theInternet provides the means for all to participate actively.     

全民健康促进评价指标体系研究

目的：制定科学的、符合当前健康促进发展的全民健康促进评价指标体系。方法：采取广泛查阅文献和总结实践经验的方式,制定指标体系框架;采取德尔菲专家咨询法构建指标体系,并在余杭区对指标体系进行现场验证。结果：49位各领域专家参与德尔菲专家咨询,2轮专家咨询的专家积极系数分别为93.88%和78.26%,专家权威系数为0.746和0.742。经现场验证,全民健康促进评价指标体系由形成性、执行性、结果、可持续性4类一级指标,健康相关资料收集、健康问题分析、目标人群分析、制定项目计划、组织管理、制度、行动、非政府组织、目标人群、公民健康素养提高、短期健康结果、长期健康结果、环境影响、突发公共卫生事件、卫生服务影响、支持环境、执行机构和人员能力17项二级指标,77项三级指标构成。结论：全民健康促进评价指标体系结构稳定,专家意见一致,并涵盖对健康促进全过程,具有较强的科学性、适用性和可行性。