Does theory inform practice in health promotion in Australia?

In recent years, there have been numerous papers discussing the importance of improving the link between health promotion researchers and practitioners. Several reviews have been undertaken to determine the extent to which health promotion research is disseminated to, and utilized by, practitioners in the development and implementation of health promotion programs. These studies have generally been limited to reviews of literature rather than directly gathering data from practitioners. This paper reports on a survey of Australian health promotion practitioners undertaken to investigate the extent to which they are aware of, understand and utilize the major health promotion theories and models derived from research in the areas of psychology and communication. We found that none of the theories or models included in this study-the 'standard' theories and models taught in health promotion courses, and included in the leading textbooks-were used by more than 50% of practitioners in their work. The only models being used by more than one-third of the practitioners were PRECEDE-PROCEED and the Transtheoretical (Stages of Change) Model. The paper concludes with possible explanations for the low level of utilization of theories and models, and suggestions for increasing their usage based on information sources accessed by these practitioners.     

Does a policy matter? Assessing the Finnish health policy in relation to its equity goals

Health differences in Finland, in terms of mortality, are the second largest among Western European countries. This is the case in spite of egalitarian social policy efforts and other health policy responses by the government. In addition, the Finnish Health for All (HFA) policy programmes pay attention to inequality in health. The two main aims of the Finnish HFA policy have been the best possible level of health for the population (the level target) and the reduction and elimination of differences in health between population groups (the distribution target). In the health policy programme discourse concerning the distribution target, it is stressed that when goals are set and action is considered, it is necessary to put special emphasis on the reduction of differences between population groups and, in particular, on the fact that measures are to be directed primarily at those groups where the problems and risks are greatest. This article aims to describe the long historical tradition of Finnish social and health policy related to the equity goal. Additionally it outlines factors and explores reasons why different policy programmes do not seem to lead to successful outcomes in terms of equity.     

Is work beneficial to good health?

Unemployment and insecurity at work are a source of stress and may create a threat to individual physical and psychological health. The purpose of this study was to examine the connection between personal, functional, and professional variables and reports of how the health of hospital patients is impacted by financial status in Israel. One hundred and forty three hospitalized patients completed demographic, health-functional, and financial status questionnaires. Of the respondents, 32.9% reported a correlation between financial status and health. Significant connections were found between family status, lack of work, a change in partner's employment status, job insecurity, and financial commitments and reports of a correlation between financial status and health. The multivariate model predicting reports of a correlation between financial status and health was statistically significant. Discussion and implications focus on the need to create special preparation among health care professionals, in the community and in hospitals, to identify and treat people suffering from financial stress.     

Does reported health promotion activity neglect people with ill-health?

Considering health as an alternative to ill-health ignores the multidimensionality of both concepts and invites neglect of health promotion as a multidimensional activity in persons with known ill-health. Drawing on the Ottawa Charter and M?ori perspectives of health, we interpret (ill) health according to people's ability to function in their environment by developing physical, psychological, social and spiritual resources for living. We use this framework to test empirically our hypothesis that although the concept of health promotion has always included people with ill-health, the practice of health promotion has continued to neglect them. Our exploratory review of articles published during 1989-99 and indexed on three electronic databases suggests widespread omission of people with ill-health from research on interventions for health promotion. Of 881 citations, approximately three-quarters included people without ill-health in any dimension. This finding could reflect a failure to include these people in health promotion, to describe activity to improve their health as health promotion, or both. Supporting the latter interpretation is uncertainty over the meaning of health, and the targeting of health promotion at groups at high risk of ill-health and 'all' persons. We need therefore to enable health promotion activity to include ill people explicitly.     

Why worry about evidence in health promotion?

This paper, in a sociological and historical perspective, aims at positioning the main issues linked to the idea of utilizing evidence-based practices in health promotion. It begins to do so by looking at the international evolution of health promotion and evidence-based practices, and by providing definitions for these concepts. In a second section, the paper analyzes how the evidence based practices approach has confronted the field of health promotion, especially since the second half of the 1990s. It argues that this has occurred in the context of the evaluative concerns put forward by governments all over the world, in order to downsize their publicly funded health systems. The reaction, often negative, of the health promotion field to evidence-based practices is also documented. Finally, some methodological and political issues raised by the idea of utilizing evidence-based practices in health promotion are presented. The paper concludes that this approach is far from a panacea but has potential limited utilization for certain kinds of health promotion practices. Alternative suggestions on how to establish "best practices" in this field are also offered.     

Is cultural activity at work related to mental health in employees?

Objective

To examine relationships between work-based cultural activities and mental employee health in working Swedes.

Hypothesis

A positive relationship between frequent cultural activity at work and good employee health was expected.

Research design

Random sample of working Swedish men and women in three waves, 2006, 2008 and 2010, on average 60 % participation rate.

Methods

A postal questionnaire with questions about cultural activities organised for employees and about emotional exhaustion (Maslach) and depressive symptoms (short form of SCL). Employee assessments of “non-listening manager” and work environment (“psychological demands” and “decision latitude”) as well as socioeconomic variables were covariates. Cross-sectional analyses for each study year as well as prospective analyses for 2006–2008 and 2008–2010 were performed.

Main outcome and results

Lower frequency of cultural activities at work during the period of high unemployment. The effects of relationships with emotional exhaustion were more significant than those with depressive symptoms. The associations were attenuated when adjustments were made for manager function (does your manager listen?) and demand/control. Associations were more pronounced during the period with low unemployment and high cultural activity at work (2008). In a prospective analysis, cultural activity at work in 2008 had an independent statistically significant “protective” effect on emotional exhaustion in 2010. No corresponding such association was found between 2006 and 2008.

Conclusions

Cultural activities at work vary according to business cycle and have a statistical association with mental employee health, particularly with emotional exhaustion.

Implications for future research

There are particularly pronounced statistical protective effects of frequent cultural activity at work on likelihood of emotional exhaustion among employees.

     

Reducing social inequalities in health: public health, community health or health promotion?

While the Consortium on 'Community Health Promotion' is suggesting a definition of this new concept to qualify health practices, this article questions the relevance of introducing such a concept since no one has yet succeeded in really differentiating the three existing processes: public health, community health, and health promotion. Based on a literature review and an analysis of the range of practices, these three concepts can be distinguished in terms of their processes and their goals. Public health and community health share a common objective, to improve the health of the population. In order to achieve this objective, public health uses a technocratic process whereas community health uses a participatory one. Health promotion, on the other hand, aims to reduce social inequalities in health through an empowerment process. However, this is only a theoretical definition since, in practice, health promotion professionals tend to easily forget this objective. Three arguments should incite health promoters to become the leading voices in the fight against social inequalities in health. The first two arguments are based on the ineffectiveness of the approaches that characterize public health and community health, which focus on the health system and health education, to reduce social inequalities in health. The third argument in favour of health promotion is more political in nature because there is not sufficient evidence of its effectiveness since the work in this area is relatively recent. Those responsible for health promotion must engage in planning to reduce social inequalities in health and must ensure they have the means to assess the effectiveness of any actions taken.     

Whither health promotion events? A judicial approach to evidence

This paper reports on a review undertaken for the Health Education Board for Scotland on 'health events'. On the basis of a literature review and interviews with 20 professionals in the UK, it appraised the effectiveness of such activities, assessed their current extent and status, and ultimately considered whether they are useful and relevant within emergent contexts. It suggests that the evidence base for health events is relatively weak, particularly given the scale of such work. At best, all that can be said is that there is some evidence that some of these events have some use within very specific assumptions and values. Consideration is given to possible ways forward. The paper also considers a series of related issues that impinge on the assessment of complex health promotion interventions. From our field interviews, health events are perceived by most to be labour intensive and ineffective. Rather, they are undertaken for a range of pragmatic 'public relations' reasons that exist independent of knowledge, attitudinal or behavioural outcomes. This ambiguity of expectation coupled with a paucity of published high-quality literature led to the use of a judicial approach to evidence appraisal. It considers the ways in which this exercise could be undertaken, ultimately being sceptical of systematic meta-reviews.     

Why do managers allocate resources to workplace health promotion programmes in countries with national health coverage?

There is extensive evidence that worksite health promotion (WHP) programmes reduce healthcare costs and improve employee productivity. In many countries, a large proportion of healthcare costs are borne by the state. While the full benefits of WHP are still created, they are shared between employers and the state, even though the employer bears the full (after-tax) cost. Employers therefore have a lower incentive to implement WHP activity. We know little about the beliefs of managers with decision responsibility for the approval and implementation of WHP programmes in this context. This article reports the results of a study of the attitudes of Canadian senior general managers (GMs) and human resource managers (HRMs) in the auto parts industry in Ontario, Canada towards the consequences of increasing discretionary spending on WHP, using Structural Equation Modelling and the Theory of Planned Behaviour. We identified factors that explain managers' intentions to increase discretionary spending on wellness programmes. While both senior GMs and HRMs are motivated primarily by their beliefs that WHP reduces indirect costs of health failure, GMs were also motivated by their moral responsibility towards employees (but surprisingly HRMs were not). Importantly, HRMs, who usually have responsibility for WHP, felt constrained by a lack of power to commit resources. Most importantly, we found no social expectation that organizations should provide WHP programmes. This has important implications in an environment where the adoption of WHP is very limited and cost containment within the healthcare system is paramount.     

More physicians in public health: less public health work?

AIM: The object was to assess changes in work priorities in local public health medicine in Norway over the period from 1994 to 1999. METHODS: Two cross-sectional studies were undertaken of physicians working in local public health medicine in all Norwegian municipalities, using a postal questionnaire. RESULTS: Half of the physicians working in public health in 1999 were recruited after 1994. Although the number of physicians working in public health increased from 505 in 1994 to 555 in 1999 (10%) an estimation of the total weekly hours worked decreased by 3.7% from 8,715 hours in 1994 to 8,386 hours in 1999. The vast majority of physicians worked in combined posts (87%), and they reduced their engagement in public health by 2.6 hours on average from 1994 to 1999. The reduction depended on remuneration model, speciality in community medicine, and municipality size. CONCLUSIONS: Local public health in Norway was under pressure in the 1990s. For public health physicians, preventive medicine lost out to clinical work. No promising signals of change in the professional or political framework or in incentives for public health work are seen.     

Should we change the focus of health promotion in sexual health clinics?

The effectiveness of sexual behaviour change interventions in sexual health clinics is unknown. Risk factors for poor sexual and reproductive health such as depression, violence, alcohol and smoking in sexual health clinics are all common and can be identified easily in sexual health services. Targeting these risk factors could be as effective as traditional sexual health promotion and could have additional benefits. The authors propose a pilot to assess the cost-effectiveness and acceptability of incorporating screening and interventions for these risk factors.     

Community involvement in health promotion: progress or panacea?

There are many arenas within which health promotion may be located. This paper addresses the issues involved in the development of health promotion in one such arena: the community health movement. This movement is complex and dynamic. When reference is made to non-statutory health action, or to community involvement in health, this complexity may not be fully appreciated. There is a tendency for the range of activity to be reduced to its most "visible" form: self-help activity. However, there is more to the community health movement than this. A typology is offered here in which three levels of community-based activity in Britain are identified. These are referred to as self-help groups, community health groups and community development health projects. The breadth and range of this activity reflects the inability of formalized health care to tackle many of the underlying causes of ill-health. Each type of community health activity exists as a declaration of this failure, but some forms of activity may be welcomed by the health professions whilst others may not. In particular the numerically small community development health projects offer a significant challenge to formal health care because they seek to encourage collective health activity by those who are least in control of their own health. It is within the context of developing strategies for health promotion that community health action is most relevant. National and local strategy documents suggest that community involvement is essential for the successful promotion of health. Fully comprehensive participation by community groups signifies a major shift in our perceptions of health and health care. An appreciation of the existing range of health action in communities is an important starting point for medical health professionals engaged in this task.     

Community involvement in health promotion: progress or panacea?

There are many arenas within which health promotion may be located.This paper addresses the issues involved in the developmentof health promotion in one such arena: the community healthmovement. This movement is complex and dynamic. When referenceis made to non-statutory health action, or to community involvementin health, this complexity may not be fully appreciated. Thereis a tendency for the range of activity to be reduced to itsmost "visible" form: self-help activity. However, there is moreto the community health movement than this. A typology is offered here in which three levels of community-basedactivity in Britain are identified. These are referred to asself-help groups, community health groups and community developmenthealth projects. The breadth and range of this activity reflectsthe inability of formalized health care to tackle many of theunderlying causes of ill-health. Each type of community healthactivity exists as a declaration of this failure, but some formsof activity may be welcomed by the health professions whilstothers may not. In particular the numerically small communitydevelopment health projects offer a significant challenge toformal health care because they seek to encourage collectivehealth activity by those who are least in control of their ownhealth. It is within the context of developing strategies for healthpromotion that community health action is most relevant. Nationaland local strategy documents suggest that community involvementis essential for the successful promotion of health. Fully comprehensiveparticipation by community groups signifies a major shift inour perceptions of health and health care. An appreciation ofthe existing range of health action in communities is an importantstarting point for medical health professionals engaged in thistask.     

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.