Health promotion: reconfiguring nurses' practice to reduce social inequalities

Inequalities in people's health due to economic or social circumstances remain a persistent challenge in the UK, with people from disadvantaged communities disproportionately likely to die earlier and experience more health issues than the general population. Health promotion has a vital role in reversing health inequalities and requires a focus on structural and political-level determinants of health, rather than individuals' lifestyle choices. However, while health promotion is a significant aspect of nurse education curricula, individual nurses may experience role confusion regarding the application of health promotion in their practice. Therefore, a shift is required in nurse education and training on health promotion, as well as its practical implementation. This article suggests some approaches that could be taken to reconfigure the role of nurses in health promotion.

Competency Status and Desire for Training in Core Public Health Domains: An Analysis by Job Level

CONTEXT

Although trainings on core public health domains are widely available, and experts concur that competency in multiple core domains (analysis/assessment, leadership, communication, etc) is desirable for public health professionals, many still lack such competency. Employee job level could be a factor, as organizational research indicates that broad skill sets often hold importance mainly for higher-level employees.

OBJECTIVE

This study examines whether the association between competency and desire for training in core public health domains depends on job level.

DESIGN

A training preferences and domain competency survey of public health professionals: nonmanagers (n = 790), middle managers (n = 332), and upper managers (n = 69). The association of competency in domains overall with number of related training topics desired was examined using median tests. The association of competency in individual domains with desire for specific related training topics was assessed using logistic regressions adjusted for education.

SETTINGS

Public health departments in the US Southwest (2013-2019).

MAIN OUTCOME MEASURES

Competence in core domains: Financial Planning and Management, Analysis/Assessment, Communication, Cultural Competency, Leadership/Systems Thinking, Policy Development/Program Planning, Public Health Sciences, and Community Dimensions of Practice. Desire for training (yes/no) in 25 domain-related topics.

RESULTS

Upper managers lacking overall competence in core domains desired more training topics than their competent counterparts (median of 12 topics vs 5, P = .02). In contrast, nonmanagers lacking overall competence desired fewer topics than their competent counterparts (4 vs 6, P < .001). Upper managers with lesser competency in an individual domain often had significantly higher odds of desiring training related to the domain, but the opposite was found for nonmanagers. Among middle managers, little association between competency and training desire was found.

CONCLUSIONS

Ideally, lesser competence in core domains would be accompanied by greater desire for ameliorative training, but only upper managers exhibited this pattern. Efforts are needed to better connect domain competency status and training desire among nonmanagers and middle managers.

Nurse’s competences in promoting women’s health in light of the Galway Consensus

ABSTRACT Objectives: to identify nurses’ competences in promoting women’s health. Methods: descriptive study with a qualitative approach that adopted the Galway Consensus as a theoretical-methodological framework. Data collection was performed through semi-structured interviews. Results: most of the Galway Consensus’ competence domains were present in the nurses’ interventions related to health promotion in women’s care. “Assessment of needs” and “Implementation” were the most highlighted domains, followed by “Leadership” and “Impact assessment”. The domain “Defending/Advocating Rights” was not identified. Final Considerations: within the nurses’ work with women, some of the Galway Consensus domains of competencies for health promotion were present. However, there is a need, in the context of continuous health education, to expand strategies and enhance the development and application of these health promotion competences.

Strengthening health promotion practice: capacity development for a transdisciplinary field

The growing burden of non-communicable and newly emerging communicable diseases, multi-morbidity, increasing health inequalities, the health effects of climate change and natural disasters and the revolution in communication technology require a shift of focus towards more preventive, people-centred and community-based health services. This has implications for the health workforce, which needs to develop new capacities and skills, many of which are at the core of health promotion. Health promotion is thus being mainstreamed into modern public health. For health promotion, this offers both opportunities and challenges. A stronger focus on the enablers of health enhances the strategic importance of health promotion's whole-of-society approach to health, showcases the achievements of health promotion with regard to core professional competencies, and helps build public health capacity with health promotion accents. On the other hand, mainstreaming health promotion can weaken its organizational capacity and visibility, and bears the risk of it being absorbed into a traditional public health discourse dominated by medical professions. To address these challenges and grasp the opportunities, it is essential for the health promotion workforce to position itself within the diversifying primary care and public health field. Taking the transdisciplinary status of health promotion and existing capacity development systems in primary and secondary prevention and health promotion as reference points, this paper considers the possibilities to integrate and implement health promotion capacities within and across disciplinary boundaries, arguing that the contribution of health promotion to public health development lies in the complementary nature of specialist and mainstreamed health promotion.

Health promotion capacity and institutional systems: an assessment of the South African Department of Health

Health promotion (HP) capacity of staff and institutions is critical for health-promoting programmes to address social determinants of health and effectively contribute to disease prevention. HP capacity mapping initiatives are the first step to identify gaps to guide capacity strengthening and inform resource allocation. In low-and-middle-income countries, there is limited evidence on HP capacity. We assessed collective and institutional capacity to prioritize, plan, deliver, monitor and evaluate HP within the South African Department of Health (DoH). A concurrent mixed methods study that drew on data collected using a participatory HP capacity assessment tool. We held five 1-day workshops (one national, two provincial and two districts) with DoH staff (n = 28). Participants completed self-assessments of collective capacity across three areas: technical, coordinating and systems capacity using a four-point Likert scale. HP capacity scores were analysed and presented as means with standard deviations (SDs). Thematic analysis of verbatim transcripts of audio-recorded group discussions that provided rationale and evidence for scores were conducted using deductive and inductive codes. At all levels, groups revealed that capacity to develop long-term, sustainable HP interventions was limited. We found limited collaboration between national and provincial HP levels. There was limited monitoring of HP indicators in the health information system. Coordination of HP efforts across different sectors was largely absent. Lack of capacity in budgeting emerged as a major challenge, with few resources available to conduct HP activities at any level. Overall, the capacity mean score was 2.08/4.00 (SD = 0.83). There is need to overcome institutional barriers, and strengthen capacity for HP implementation, support and evaluation within the South African DoH.

The IUHPE Health Promotion Accreditation System - developing and maintaining a competent health promotion workforce

This commentary reports on the development and implementation of the competency-based IUHPE Health Promotion Accreditation System in the context of workforce capacity as a key activity of the International Union for Health Promotion and Education (IUHPE). The process of developing the System is described, including how it built on, and added to, international research and experience in competency-based approaches to health promotion. An overview of how the System works, its current status and future plans, is presented. Evidence of the positive impact of the System to date, in particular in the context of health promotion education, is considered.

Transformative health promotion: what is needed to advance progress?

Transformative health promotion actions are needed to achieve health equity and the Sustainable Development Goals (SDGs), advance human and planetary wellbeing, and ensure that we build back better post-COVID-19. Health policies and systems need to be aligned with the values, principles and strategies of health promotion and investment made in strengthening essential health promotion functions. This paper considers how transformative health promotion can be advanced, by reflecting critically on what progress needs to be made and the structures and processes that are required to strengthen health promotion at a systems level. Progress in implementing health promotion is variable, and there is a general lack of investment in developing the necessary health promotion systems for substantive progress to be made. Key enablers and system requirements for comprehensive health promotion are examined, including the following critical elements: (i) effective advocacy for the concept and practice of health promotion; (ii) enabling policy structures for universal health promotion actions on a cross-sectoral basis; (iii) effective implementation systems, support mechanisms and workforce capacity for multisectoral health promotion action; (iv) investment in innovative research methods and knowledge translation to inform transformative health promotion approaches. In strengthening capacity to implement transformative health promotion actions, political will needs to be mobilized to ensure that dedicated and sustainable funding is made available, and the organizational and workforce capacity to deliver effective health promotion interventions is in place. The International Union for Health Promotion and Education (IUHPE) plays a central role in advancing transformative health promotion through mobilising and supporting its global members and partners in strengthening health promotion systems.

Family Health Postgraduate Program in the Brazilian northeast: repercussions in the professional exercise of postgraduates

Brazilian postgraduate education has grown in recent years, but there is a knowledge gap regarding whether the course's planned educational objective is being achieved. We aimed to evaluate the contribution of the Postgraduate Program in Family Health for the postgraduates' professional practice. This is a cross-sectional study conducted with 225 postgraduates from October 2019 to July 2020. Data were collected by an online questionnaire containing different sociodemographic and educational variables and competencies developed in the master's degree program and identifying the domains of Health Promotion Competencies. Most of the participants were female (78.2%), nurses (58.2%), public servants (64%), and SUS workers (93.3%). Two hundred and twenty-two (98.7%) postgraduates' final paper theme built on a practice-related issue. A high mean score was observed for all competencies analyzed. The mean scores for domains in Health Promotion competencies were high. We can conclude that the postgraduate program has contributed satisfactorily to the formation of critical, active masters, with competencies developed and being realized in professional practice.

Competencies in health promotion by nurses for adolescents

OBJECTIVE

to describe the health promotion competency domains, performed by nurses, for adolescents, according to the Galway Consensus.

METHOD

a qualitative study based on the Galway Consensus theoretical methodological framework. Fifteen nurses from northeastern Brazil participated. Data were collected between April and May 2017 through pre-structured interviews, submitted to the content analysis technique and analyzed according to the Galway Consensus dimensions.

RESULTS

the following competency areas were found: catalyzing changes, leadership, needs assessment, planning, implementation, and partnerships. These competencies were contemplated from embracement of adolescents at health unit, guidance, teamwork, educational activities and lectures, as well as active search.

CONCLUSION

most health promotion domains were observed; however, it is still suggested that there are challenges to an effective performance of health promotion among adolescents because some competency domains in health promotion have not been evidenced.

Health habits of nursing students: A longitudinal study of health perceptions and health habits

AIMS AND OBJECTIVES

To examine nursing students' health habits. More specifically, the objectives were to determine whether there were any changes in their health habits during their course of study, and to understand whether the students' perceptions about good health conditions cohered with their health-related behaviour.

BACKGROUND

The transition from high school to university has an undesirable effect on students' health habits, and nursing students' unhealthy behaviours may prevent them from helping patients improve their poor health habits.

DESIGN

A longitudinal design was used. The study followed the recommendations of STROBE (Strengthening the Reporting of Observational studies in Epidemiology).

METHODS

All students were recruited from a nursing science degree course in an Italian university. The sample consisted of 351 nursing students. Data were collected at the baseline during their entrance into the university (T0) and at the end of their third year of coursework (T3). We developed the Nursing Student Health Habits Scale, which was administered by a trained researcher. The McNemar test and the Wilcoxon signed-rank test to evaluate the differences in health habits between T0 and T3, and a logistics model to assess the factors influencing students' good health perceptions were used.

RESULTS

From T0 to T3, there were decreases in the number of students who requested physician consultations (p = .01) and increases in those who exercised daily (p = .003). There was also a change in the nutrition model (p = .018). In the multivariate model, physician consultations for medical problems and performing physical exercise were factors influencing good health perceptions.

CONCLUSIONS

Future research is needed to illuminate other aspects of students' health habits.

RELEVANCE TO CLINICAL PRACTICE

Universities are advised to address these problems by reflecting on undergraduate and postgraduate curriculum content concerning health management and disease prevention.

Implementing without guidelines, learning at the coalface: a case study of health promoters in an era of community health workers in South Africa

Background

Internationally, there has been renewed focus on primary healthcare (PHC). PHC revitalisation is one of the mechanisms to emphasise health promotion and prevention. However, it is not always clear who should lead health promotion activities. In some countries, health promotion practitioners provide health promotion; in others, community health workers (CHWs) are responsible. South Africa, like other countries, has embarked on reforms to strengthen PHC, including a nationwide CHW programme – resulting in an unclear role for pre-existing health promoters. This paper examined the tension between these two cadres in two South African provinces in an era of primary health reform.

Methodology

We used a qualitative case study approach. Participants were recruited from the national, provincial, district and facility levels of the health system. Thirty-seven face-to-face in-depth interviews were conducted with 16 health promotion managers, 12 health promoters and 13 facility managers during a 3-month period (November 2017 to February 2018). Interviews were audio-recorded and transcribed verbatim. Both inductive and deductive thematic content analysis approaches were used, supported by MAXQDA software.

Results

Two South African policy documents, one on PHC reform and the other on health promotion, were introduced and implemented without clear guidelines on how health promoter job descriptions should be altered in the context of CHWs. The introduction of CHWs triggered anxiety and uncertainty among some health promoters. However, despite considerable role overlap and the absence of formal re-orientation processes to re-align their roles, some health promoters have carved out a role for themselves, supporting CHWs (for example, providing up-to-date health information, jointly discussing how to assist with health problems in the community, providing advice and household-visit support).

Conclusions

This paper adds to recent literature on the current wave of PHC reforms. It describes how health promoters are ‘working it out’ on the ground, when the policy or process do not provide adequate guidance or structure. Lessons learnt on how these two cadres could work together are important, especially given the shortage of human resources for health in low- and middle-income settings. This is a missed opportunity, researchers and policy-makers need to think more about how to feed experience/tacit knowledge up the system.

Implementation of Health Promotion Competencies in Ireland and Italy-A Case Study

This paper reports on a case study that explored the broader contextual factors influencing the implementation of the CompHP Core Competencies at a country level in Ireland and Italy between 2011 and 2018. The sample comprised key informants who were Health Promotion experts and were knowledgeable about how the competencies had been used in their country. These experts formed National Reference Groups that guided the research process in each country and helped identify additional key informants. Qualitative methods were utilized consisting of a desk review and semi-structured interviews. The data from each country were analyzed separately using a thematic analysis approach, with the findings then compared and reviewed by the National Reference Groups. A total of 26 interviews were completed (13 in each country). The findings show that both the focus and rate of progress of implementing the competencies differed across the two countries and that this reflected their levels of Health Promotion infrastructure and capacity development. A lack of awareness of the competencies was identified as a major limiting factor in implementation in both countries, of particular concern in relation to employers and decision-makers. While the case study focused on implementing the competencies in two European countries, there are insights from their experience that can inform implementation in other countries. The study also begins to address the gap in empirical evidence on the use and impact of Health Promotion competencies and the factors that influence their implementation.

Has the Development of Health Promotion Competencies Made a Difference? A Scoping Review of the Literature

Introduction. Competency-based approaches have been developed in health promotion over the past four decades but, to date, there has been limited focus on the evaluation of their use and impact. In 2016, 5 years after publication of the CompHP Core Competencies Framework for Health Promotion, an evaluation of their use and impact across the health promotion community in Europe was initiated. As a first step in this process, a scoping review of the literature was undertaken which aimed to explore the current status of health promotion competencies, with a particular focus on developments in Europe and ascertain what evidence exists about the use and impact of health promotion competencies on practice, education, and training. Method. Searches of the electronic databases and gray literature were conducted between February 2016 and December 2017. The searches were limited to sources published in English between 2009 and 2017, which focused on health promotion competencies. Results. A total of 39 sources were identified for in-depth analysis, of which 26 were theoretical papers and 13 were papers reporting on empirical studies. Many of the sources presented health promotion competency frameworks or described their development. Some examples of the use of health promotion competencies were found but only two instances of their evaluation were identified. Conclusions. The review found few empirical studies on the implementation and use of health promotion competencies and highlights a lack of evaluation studies on their impact on practice, education, and training.

Constructing a general competency model for Chinese public health physicians: a qualitative and quantitative study

Background

The purpose of the study was to construct a general model of the competencies required by Chinese public health physicians. This study is intended to lay the foundation for promoting reform of public health education in China, and may help perfect the testing and grading system of public health courses.

Methods

The behavioral event interviews were used to collect data on knowledge, skills and performance characteristics of public health physicians for coping with public health events. A random stratified sampling survey was used to select public health professionals and workers from different public health institutions in 14 provinces (municipalities or autonomous regions) of China. We then purposively selected 150 senior public health professionals from various agencies and 85 senior public health educators at colleges and universities to take part in the checklist survey. Finally, three times expert consultations were performed to determine the dimensions and elements of the general competency model for Chinese public health physicians.

Results

The age range of the 3245 participants was 18–65 years old. When comparing public health professionals and public health education specialists, we found significant differences in the perceived importance of the core competencies between these groups. The model was revised several times and finalized through the expert consultations, and comprised seven competency dimensions.

Conclusion

The final public health practitioner competency model comprised seven competency dimensions: basic knowledge of medicine, public health knowledge, health management and health promotion, specialized skills, research and development, comprehensive abilities and professionalism.

Establishing Competencies for a Global Health Workforce: Recommendations from the Association of Pacific Rim Universities

BACKGROUND

The Association of Pacific Rim Universities Global Health Program facilitates exchange of information, knowledge and experiences in global health education and research among its 50 member universities. Despite the proliferation of global health educational programs worldwide, a lack of consensus exists regarding core competencies in global health training and how these are best taught.

METHODS

A workshop was convened with 30 faculty, university administrators, students, and NGO workers representing both the Global North and South to gain consensus on core competencies in masters'-level global health training. The co-authors then collaborated to refine the list of competencies, categorize them into domains, and develop a plan for how academic institutions can ensure that these competencies are effectively taught.

FINDINGS

Nineteen competencies across five domains were identified: knowledge of trends and determinants of global disease patterns; cultural competency; global health governance, diplomacy and leadership; project management; and ethics and human rights. The plan for how academic institutions can best train students on these competencies outlined five key opportunities: coursework; practicums; research opportunities; mentorship; and evaluation. The plan recommended additional institutional strategies such as maximizing collaborative research opportunities, international partnerships, capacity-building grants, and use of educational technology to support these goals.

CONCLUSIONS AND RECOMMENDATIONS

While further research on the implementation of competency-based training is warranted, this work offers a step forward in advancing competency-based global health masters' education as identified by a globally diverse group of expert stakeholders and economies. Given the challenges facing the current global health landscape, comparable competency-based training across institutions is critical to ensure the training of competent global health professionals.

Nursing care of overweight children: A concept analysis

AIM

To report an analysis of the concept nursing care of overweight children.

BACKGROUND

Patient care is the essence of nursing practice. Nursing professionals must define how to serve specific population groups, including overweight children, presenting real solutions to their problem. A clear conceptual analysis is necessary to unify nursing language and to contribute to nursing practice.

DESIGN

Concept analysis.

DATA SOURCES

The following databases were searched: COCHRANE, SCOPUS, LILACS, CINAHL, MEDLINE/PubMed, and CAPES Theses Library of Brazil.

REVIEW METHODS

Walker and Avant's concept analysis methodology was adopted in this study. Twenty-two articles were analyzed, and the uses, attributes, antecedents, and outcomes of the concept were identified. The nursing care assumptions proposed by Virginia Henderson comprised the theoretical referential.

RESULTS

The attributes of nursing care for overweight children included investigation, guidance, and monitoring of dietary, clinical, academic, and social aspects, along with evaluation of lifestyle and anthropometric data related to the affected children and their families.

CONCLUSION

This study enabled the construction of a defined concept for nursing care of overweight children that may be useful in the construction of a medium-range theory. Further research is recommended to verify the usefulness of the nursing approach.

Effectiveness of capacity building interventions relevant to public health practice: a systematic review

Background

This systematic review assessed the effectiveness of capacity building interventions relevant to public health practice. The aim is to inform and improve capacity building interventions.

Methods

Four strategies were used: 1) electronic database searching; 2) reference lists of included papers; 3) key informant consultation; and 4) grey literature searching. Inclusion (e.g., published in English) and exclusion criteria (e.g., non-English language papers published earlier than 2005) are outlined with included papers focusing on capacity building, learning plans, or professional development plans within public health and related settings, such as non-governmental organizations, government, or community-based organizations relating to public health or healthcare. Outcomes of interest included changes in knowledge, skill or confidence (self-efficacy), changes in practice (application or intent), and perceived support or supportive environments, with outcomes reported at the individual, organizational or systems level(s). Quality assessment of all included papers was completed.

Results

Fourteen papers were included in this review. These papers reported on six intervention types: 1) internet-based instruction, 2) training and workshops, 3) technical assistance, 4) education using self-directed learning, 5) communities of practice, and 6) multi-strategy interventions. The available literature showed improvements in one or more capacity-building outcomes of interest, mainly in terms of individual-level outcomes. The available literature was moderate in quality and showed a range of methodological issues.

Conclusions

There is evidence to inform capacity building programming and how interventions can be selected to optimize impact. Organizations should carefully consider methods for analysis of capacity building interventions offered; specifically, through which mechanisms, to whom, and for which purpose. Capacity-building interventions can enhance knowledge, skill, self-efficacy (including confidence), changes in practice or policies, behaviour change, application, and system-level capacity. However in applying available evidence, organizations should consider the outcomes of highest priority, selecting intervention(s) effective for the outcome(s) of interest. Examples are given for selecting intervention(s) to match priorities and context, knowing effectiveness evidence is only one consideration in decision making. Future evaluations should: extend beyond the individual level, assess outcomes at organizational and systems levels, include objective measures of effect, assess baseline conditions, and evaluate features most critical to the success of interventions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5591-6) contains supplementary material, which is available to authorized users.

Training of adolescent multipliers from the perspective of health promotion core competencies

ABSTRACT Objective: Recognize the domains of health promotion core competencies in the training process of adolescents carried out by nursing students. Method: Qualitative and descriptive study, which used the theoretical methodological contribution Developing Competencies and Professional Standards for Health Promotion Capacity Building in Europe (CompHP), carried out with 14 nursing students. Results: There were four domains: Enable Change; Mediate through Partnership; Communication; and Leadership. These domains came from the interest and commitment of adolescents in intersectoral partnership, the use of communication techniques, and the role of facilitator to catalyze learning and empowerment. Conclusion: There were some domains of core competency in the training of adolescents, suggesting that nursing students act as health promoters. Challenges for Nursing are the implementation of a theoretical contribution of CompHP in undergraduate and ongoing training to carry out health promotion action.

Skills, systems and supports: An Aboriginal Community Controlled Health Service (Apunipima) approach to building health promotion evaluation capacity of staff

ISSUE ADDRESSED

Building the health promotion evaluation capacity of a workforce requires more than a focus on individual skills and confidence. We must also consider the organisational systems and supports that enable staff to embed learnings into practice. This paper describes the processes used to build health promotion evaluation capacity of staff in an Aboriginal Community Controlled Health Service (ACCHS).

METHODS

To build health promotion evaluation capacity three approaches were used: (i) workshops and mentoring; (ii) strengthening systems to support program reporting; and (iii) recruitment of staff with skills and experience. Pre- and post-questionnaires determined levels of individual skills and confidence, updated systems were assessed for adequacy to support new health promotion practices and surveys captured the usefulness of workshops and mentoring.

RESULTS

There was increased participant skills and confidence. Participants completed program impact evaluation reports and results were successfully presented at national conferences. The health promotion team was then able to update in-house systems to support new health promotion practices. Ongoing collaboration with experienced in-house researchers provided basic research training and professional mentoring.

CONCLUSIONS

Building health promotion evaluation capacity of staff in an ACCHS can be achieved by providing individual skill development, strengthening organisational systems and utilising professional support. SO WHAT?: Health promotion practitioners have an ongoing professional obligation to improve the quality of routine practice and embrace new initiatives. This report outlines a process of building evaluation capacity that promotes quality reporting of program impacts and outcomes, reflects on ways to enhance program strengths, and communicates these findings internally and to outside professional bodies. This is particularly significant for ACCHSs responsible for addressing the high burden of preventable disease in Aboriginal and Torres Strait Islander populations.

COMPETÊNCIAS DO ENFERMEIRO NA PREVENÇÃO DE QUEDAS EM CRIANÇAS À LUZ DO CONSENSO DE GALWAY

RESUMO Objetivo: analisar as competências do enfermeiro na prevenção de quedas de crianças hospitalizadas, à luz do Consenso de Galway. Método: estudo transversal, realizado com 40 enfermeiras que atuavam nas unidades abertas de internação de um hospital pediátrico. Coleta dos dados realizada mediante aplicação de um questionário com conteúdo validado. Foram relacionadas as ações executadas pelas enfermeiras, segundo o protocolo de prevenção de quedas, com os oito domínios do modelo de competências para promoção da saúde de Galway. Procedeu-se à análise estatística e análise do desempenho dos profissionais. Resultado: o domínio de competência liderança esteve presente em todas as ações (15). Os demais domínios de competência apresentaram-se na nas seguintes frequências: defesa (9 ações), catalisar mudanças (6 ações), implementação (6 ações), planejamento (3 ações), parcerias (3 ações), avaliação das necessidades (2 ações) e avaliação do impacto (2 ações). Conclusão: os domínios de competência foram contemplados em pelo menos duas ações de prevenção de quedas. Destaca-se a importância da identificação das competências de enfermeiros na prevenção de quedas de crianças hospitalizadas, visando melhoria da qualidade assistencial e, consequentemente, redução de atos inseguros.

Introduction to Global Health Promotion

Global health education is becoming increasingly prominent in universities throughout the country especially in programs focused on health and behavioral sciences, law, economics, and political science. Introduction to Global Health Promotion is a book that can be used by both instructors and students in the field of global health. The book provides theories and models, human rights, and technology relevant to the field. In addition the book is designed to share best evidence for promoting health and reducing morbidity and mortality in a variety of areas. The book can be used by health educators, public health practitioners, professors, and students as a resource for research and practice in the field of health promotion and disease prevention.

Educational Attainment of the Public Health Workforce and Its Implications for Workforce Development

This study ascertains the levels of educational attainment among state health agency employees as well as the correlates of attainment.

Educational attainment is a critical issue in public health workforce development. However, relatively little is known about the actual attainment of staff in state health agencies (SHAs).

The Public Health Workforce Interests and Needs Survey: The First National Survey of State Health Agency Employees

This article describes a nationally representative survey of central office employees at state health agencies to characterize key components of the public health workforce.

Public health practitioners, policy makers, and researchers alike have called for more data on individual worker's perceptions about workplace environment, job satisfaction, and training needs for a quarter of a century. The Public Health Workforce Interests and Needs Survey (PH WINS) was created to answer that call.

"If You Don't Do Parking Management .. Forget Your Behaviour Change, It's Not Going to Work.": Health and Transport Practitioner Perspectives on Workplace Active Travel Promotion

OBJECTIVES

After having conducted two studies of the effectiveness of workplace travel plans for promoting active travel, we investigated health and transport practitioners' perspectives on implementing workplace travel plans to share some of the lessons learnt. The objectives of this study were to describe perceived elements of effective workplace travel plans, barriers and enablers to workplace travel planning, their experiences of working with the other profession on travel plan implementation, their recommendations for workplace travel planning, and also to explore similarities and differences in transport and health practitioner perspectives.

MATERIALS AND METHODS

Fourteen health and ten transport practitioners who had prior involvement in workplace travel plan programs were purposefully selected from workplaces in Australia. We conducted 20 in-depth interviews since data saturation had been reached at this point, and data were subject to framework analysis.

RESULTS

Perceived essential elements of effective workplace travel plans included parking management; leadership, organisational commitment and governance; skills and other resources like a dedicated travel plan coordinator; and, pre-conditions including supportive transport infrastructure in the surrounds. Recommendations for promoting travel plans included supportive government policy, focusing on business benefits and working at different scales of implementation (e.g. single large worksites and business precincts). Health and transport practitioner perspectives differed, with transport practitioners believing that parking management is the key action for managing travel demand at a worksite.

CONCLUSIONS

Health practitioners implementing travel plans may require training including concepts of travel demand management, and support from transport planners on parking management strategies. Promoting an understanding of the shared travel behaviour change skills of transport and health practitioners may assist further collaboration. For take-up by organisations to be of sufficient scale to create meaningful population level reductions in driving and increases in active travel, promotion and travel plans should be focused on the priorities of the organisations. Supportive government policy is also required.

Competências do enfermeiro na promoção da saúde de indivíduos com cardiopatias crônicas

RESUMO Objetivo: identificar as competências do enfermeiro relacionadas à promoção da saúde de indivíduos com cardiopatas crônicas, à luz do Consenso de Galway. Método: revisão integrativa da literatura, com busca de artigos publicados entre os anos de 2010 e 2014, nas bases de dados LILACS, BDENF, IBECS; e no portal PubMed, em fevereiro de 2015. Os 21 artigos selecionados foram analisados de acordo com os oito domínios de competências: Catalisar mudanças, Liderança, Avaliação das necessidades, Planejamento, Implementação, Avaliação do impacto, Defesa de direitos e Parcerias. Resultados: todos os domínios de competências foram contemplados nas intervenções do enfermeiro na promoção da saúde de cardiopatas crônicos, sendo o Planejamento e a Avaliação os mais evidenciados. Conclusão: os resultados desta pesquisa destacaram o enfermeiro como agente capaz de operar a gestão do cuidado, com vistas a melhorar articulação deste último com o trabalho e educação e, desta maneira, a assistência à saúde da população.

Thinking beyond the silos: emerging priorities in workforce development for state and local government public health agencies

CONTEXT

Discipline-specific workforce development initiatives have been a focus in recent years. This is due, in part, to competency-based training standards and funding sources that reinforce programmatic silos within state and local health departments.

OBJECTIVE

National leadership groups representing the specific disciplines within public health were asked to look beyond their discipline-specific priorities and collectively assess the priorities, needs, and characteristics of the governmental public health workforce.

DESIGN

The challenges and opportunities facing the public health workforce and crosscutting priority training needs of the public health workforce as a whole were evaluated. Key informant interviews were conducted with 31 representatives from public health member organizations and federal agencies. Interviews were coded and analyzed for major themes. Next, 10 content briefs were created on the basis of priority areas within workforce development. Finally, an in-person priority setting meeting was held to identify top workforce development needs and priorities across all disciplines within public health.

PARTICIPANTS

Representatives from 31 of 37 invited public health organizations participated, including representatives from discipline-specific member organizations, from national organizations and from federal agencies.

RESULTS

Systems thinking, communicating persuasively, change management, information and analytics, problem solving, and working with diverse populations were the major crosscutting areas prioritized.

CONCLUSIONS

Decades of categorical funding created a highly specialized and knowledgeable workforce that lacks many of the foundational skills now most in demand. The balance between core and specialty training should be reconsidered.

Ensino da promoção da saúde em pós-graduação em saúde pública internacional no contexto do processo de Bolonha

Resumo Nas décadas recentes tem sido destacada a necessidade de renovar a educação superior por meio do processo de Bolonha para responder às exigências de uma nova sociedade. Simultaneamente, a saúde pública e a promoção da saúde têm evoluído no sentido de concretizar a aspiração de aumentar os anos de vida saudáveis, diminuir as desigualdades em saúde e enfrentar os múltiplos problemas de saúde que afetam as populações na atualidade. Essa evolução tem suscitado a reflexão sobre os desafios da formação, investigação e implementação prática dessas disciplinas. Neste texto, pretende-se produzir uma visão integradora das especificidades do ensino de promoção da saúde e de seu lugar na progressão da formação do estudante em Saúde Pública Internacional, apresentando como exemplo a integração da disciplina no programa de pós-graduação do Instituto de Higiene e Medicina Tropical em Portugal. A proposta de ensino apresentada procura contribuir para a formação de uma massa crítica de profissionais informados e com competências para atuar na formulação de políticas e na implementação de estratégias que contribuam para a melhoria da saúde das populações. Numa perspetiva de política educativa, prover conhecimentos, competências e valores aos profissionais para traduzir teoria e investigação em políticas e práticas efetivas é essencial para fortalecer a promoção da saúde global.

The Pan-University Network for Global Health: framework for collaboration and review of global health needs

In the current United Nations efforts to plan for post 2015-Millennium Development Goals, global partnership to address non-communicable diseases (NCDs) has become a critical goal to effectively respond to the complex global challenges of which inequity in health remains a persistent challenge. Building capacity in terms of well-equipped local researchers and service providers is a key to bridging the inequity in global health. Launched by Penn State University in 2014, the Pan University Network for Global Health responds to this need by bridging researchers at more than 10 universities across the globe. In this paper we outline our framework for international and interdisciplinary collaboration, as well the rationale for our research areas, including a review of these two themes. After its initial meeting, the network has established two central thematic priorities: 1) urbanization and health and 2) the intersection of infectious diseases and NCDs. The urban population in the global south will nearly double in 25 years (approx. 2 billion today to over 3.5 billion by 2040). Urban population growth will have a direct impact on global health, and this growth will be burdened with uneven development and the persistence of urban spatial inequality, including health disparities. The NCD burden, which includes conditions such as hypertension, stroke, and diabetes, is outstripping infectious disease in countries in the global south that are considered to be disproportionately burdened by infectious diseases. Addressing these two priorities demands an interdisciplinary and multi-institutional model to stimulate innovation and synergy that will influence the overall framing of research questions as well as the integration and coordination of research.

Teacher Competencies in Health Education: Results of a Delphi Study

OBJECTIVE

The aim of this research study was to identify the core competencies for health education teachers in supporting the development of health literacy among their students.

METHOD/RESULTS

A three round Delphi method was employed. Experts in health education were asked to identify core competencies for school health educators. Twenty six participants from the academic field were invited to participate in the study. Twenty participants completed the first round of the Delphi, while eighteen took part in round two and fifteen participated in the final round. Data were collected using an electronic questionnaire. The first round contained an open ended question in which participants were asked to name and define all the competencies they perceived were important. Thematic analysis was undertaken on these data. A list of 36 competencies was created from this round. This list was then returned to the same participants and they were asked to rate each competency on a 7 point semantic differential scale in terms of importance. The resulting data were then analysed. For the final round, participants were presented with a list of 33 competencies and were asked to rank them again, in order of importance.

CONCLUSION

Twelve core competencies emerged from the analysis and these competencies comprised of a mixture of knowledge, attitude and skills. The authors suggest that how these competencies are achieved and operationalised in the school context can be quite complex and multi-faceted. While the authors do not seek to generalise from the study they suggest that these competencies are an important input for all stakeholders, in order to question national and international teacher guidelines. In addition the competencies identified may provide a useful starting point for others to undertake deeper analysis of what it means to be an effective health educator in schools.

Avaliação das competências de enfermeiras para a promoção em saúde durante atendimentos pediátricos em unidade de emergência

Resumo Objetivo Avaliar as competências de enfermeiras na promoção da saúde durante atendimentos pediátricos em unidade de emergência, utilizando a classificação de risco. Métodos Estudo transversal realizado com enfermeiras que atuam no acolhimento com classificação de risco das crianças atendidas na emergência. Foram relacionados os procedimentos desenvolvidos pelas enfermeiras segundo as diretrizes do acolhimento com classificação de risco com o modelo de competências para a promoção da saúde de Galway. Na análise das competências, as enfermeiras foram acompanhados por dois observadores. Para a confiabilidade interobservadores foi utilizado o índice de Kappa, que corresponde a uma medida de concordância que varia de 0 a 1, sendo o valor 0 nenhuma concordância e o 1 representa total concordância. Resultados As competências identificadas na Enfermeira 1 obteve concordância perfeita (K=1,0), na Enfermeira 2 concordância moderada (K=0,5) e na Enfermeira 3 concordância muito baixa (K=0,2). Das competências de Galway, obtiveram maior concordância avaliação/diagnóstico e parceria. Conclusão As competências para promoção da saúde desenvolvidas pelas enfermeiras participantes do estudo foram: avaliação/diagnóstico, parceria, planejamento e avaliação das ações.

Competencies em promoção da saúde: desafios da formação

O CompHP foi desenvolvido na Europa, em 2012, com o intuito de estabelecer competências e um sistema de certificação para a Promoção da Saúde. Este artigo tem o objetivo de apresentar uma reflexão teórica a respeito das possibilidades e limites da utilização do CompHP na formação de profissionais de saúde no Brasil. As bases teóricas que dão suporte a essa reflexão foram buscadas na literatura científica e ajustadas nos debates que aconteceram no interior de uma disciplina de pósgraduação stricto sensu, em 2012. Diversos trabalhos têm discutido e elaborado diretrizes para o estabelecimento de competências em promoção da saúde em todo o mundo, porém, as discussões sobre competências profissionais para a promoção da saúde que têm sido construídas no Brasil são ainda circunscritas a determinadas práticas profissionais. A partir das análises dos textos científicos, fica evidente que as diretrizes do CompHP foram cunhadas para se pensar a formação e a prática em promoção da saúde no contexto europeu, porém, as características do modelo de formação profissional praticado no Brasil podem se beneficiar muito com a proposta de competências que este documento traz.

Using health promotion competencies for curriculum development in higher education

Health promotion core competencies are used for a variety of reasons. Recently there have been moves to gain international consensus regarding core competencies within health promotion. One of the main reasons put forward for having core competencies is to guide curriculum development within higher education institutions. This article outlines the endeavours of one institution to develop undergraduate and postgraduate curricula around the Australian core competencies for health promotion practitioners. It argues that until core competencies have been agreed upon internationally, basing curricula on these carries a risk associated with change. However, delaying curricula until such risks are ameliorated decreases opportunities to deliver dynamic and current health promotion education within higher institutions.

Supporting health promotion practitioners to undertake evaluation for program development

BACKGROUND

The vital role of evaluation as integral to program planning and program development is well supported in the literature, yet we find little evidence of this in health promotion practice. Evaluation is often a requirement for organisations supported by public funds, and is duly undertaken, however the quality, comprehensiveness and use of evaluation findings are lacking. Practitioner peer-reviewed publications presenting evaluation work are also limited. There are few published examples where evaluation is conducted as part of a comprehensive program planning process or where evaluation findings are used for program development in order to improve health promotion practice.

DISCUSSION

For even the smallest of programs, there is a diverse array of evaluation that is possible before, during and after program implementation. Some types of evaluation are less prevalent than others. Data that are easy to collect or that are required for compliance purposes are common. Data related to how and why programs work which could be used to refine and improve programs are less commonly collected. This finding is evident despite numerous resources and frameworks for practitioners on how to conduct effective evaluation and increasing pressure from funders to provide evidence of program effectiveness. We identify several organisational, evaluation capacity and knowledge translation factors which contribute to the limited collection of some types of data. In addition, we offer strategies for improving health promotion program evaluation and we identify collaboration of a range of stakeholders as a critical enabler for improved program evaluation.

SUMMARY

Evaluation of health promotion programs does occur and resources for how to conduct evaluation are readily available to practitioners. For the purposes of program development, multi-level strategies involving multiple stakeholders are required to address the organisational, capacity and translational factors that affect practitioners' ability to undertake adequate evaluation.

Operationalising and piloting the IUHPE European accreditation system for health promotion

The International Union for Health Promotion and Education (IUHPE) European Accreditation System for Health Promotion aims to promote quality assurance in health promotion practice, education and training. The System is designed to be flexible and sensitive to the different contexts for health promotion practice, education and training in Europe, while maintaining robust criteria. These competency-based criteria were developed in the CompHP Project (2009–2012) that developed core competencies, professional standards and an accreditation framework for health promotion practice, education and training in the context of workforce capacity development in Europe.

This paper describes how consultations undertaken with the health promotion community informed the structure and processes of the IUHPE Accreditation System. An overview of its development, key functions and the piloting of its implementation, which was co-funded by the European Union in the context of the EU Health Programme, is presented.

Feedback from consultations with key health promotion stakeholders in Europe indicated overall support for the development of an accreditation system for health promotion. However, a number of potential barriers to its implementation were noted including: absence of dedicated practitioners and professional bodies in some countries; lack of clarity about professional boundaries; lack of financial resources required to facilitate capacity building; and concerns about the costs, objectivity and transparency of the system. Feedback from the consultations shaped and informed the process of designing an operational accreditation system to ensure that it would be responsive to potential users’ needs and concerns.

Based on the agreed structures and processes, a web-based application system was developed and managed at IUHPE headquarters. A governance structure was established together with agreed policies and procedures for the System. During the pilot period, applications from 20 health promotion practitioners, two health promotion education programmes and one national accreditation organisation were processed. Feedback from the piloting stage will inform further refinement of the system.

While recognising the challenges, the overall positive feedback and the commitment demonstrated by the health promotion community form a constructive platform for the implementation of the IUHPE Accreditation System in Europe and internationally.

The creation and implementation of the newly implemented Korean Health Education Specialist certification

Professional competencies, standards, and professional preparation of public health professionals, which includes health education and health promotion competencies, is documented in Australia, Europe, Japan, and the United States. Preparing a competent public health education workforce is a newly established priority of the South Korean Ministry of Health and Welfare. In 2010, the first ever Health Education Specialist credential was implemented in South Korea. This commentary describes the creation and implementation of the Health Education Specialist credential and initial workforce preparation outcomes of the new credential.

Les artisans du changement : autour d’un échange plénier

La plénière de clôture du colloque a été le lieu d’échange entre quatre panélistes et les participants au colloque. Les panélistes étaient : Luc Berghmans, médecin et directeur de l’Observatoire de la santé du Hainaut en Belgique, Louise Bouchard, sociologue et professeure au Département de sociologie et anthropologie de l’Université d’Ottawa au Canada, Michel O’Neill, sociologue et professeur à la Faculté des sciences infirmières de l’Université Laval, Québec, Canada et Philippe Lorenzo, directeur général de l’Instance régionale d’éducation et de promotion de la santé (Ireps) de Picardie à Amiens, en France. Louise Potvin, professeure à l’Université de Montréal qui a agi comme modératrice de la plénière, a réalisé la synthèse qui suit. Dans la foulée du colloque, trois questions ont fait l’objet du débat. À quel point faut-il mettre la santé au premier plan de l’action locale si l’on veut promouvoir des valeurs d’équité ? Comment doit-on organiser et articuler l’action aux plans local, régional, national et mondial ? Qui sont les partenaires et quelles formes de gouvernance sont à mettre en place ? Quels sont les paramètres pour définir les rôles, tâches et compétences des opérateurs des programmes locaux et régionaux de santé, artisans du changement ?

Chaque panéliste devait répondre à deux des trois questions. Nous rendons compte ici des réponses que les panélistes ont apportées à ces questions. Comme il est impossible de vérifier les informations qui soutiennent les points de vue exprimés par l’auditoire, nous ne rapportons ici que la teneur des propos, sans faire état des exemples utilisés.

Nursing: promoting the health of overweight children and adolescents in the school context

The study aimed to analyze the nursing interventions related to the competencies of health promotion of overweight children and adolescents in the school context, in light of the Galway Consensus through an integrative review. Articles published between 1988 and June, 2013 were found in the databases CINAHL, SCOPUS, MEDLINE/PubMed, Cochrane, LILACS and SciELO. A total of 139 publications were obtained from indexed descriptors. Ten articles were selected after reading. The most evident competencies for health promotion were: catalyzing change, needs assessment and impact assessment. The highlights were activities of health education and partnerships with other health professionals and the families of students. It was found that the skills of health promotion developed by nurses can contribute to the adoption of healthy habits by overweight children and adolescents.

[Professional competences in Public Health: concepts, origins, approaches and applications]

Professional competences are an issue that has been much discussed in several areas including health. The need for new modes of work processes as a result of the change in model of care and epidemiology of diseases has sparked discussion and debate in this area. In this context, the objective of this paper is to present a review of the construct of competence to understand their socio-historical context and their applicability in the context of health. It was presented the main approaches cited in the literature and their diverse backgrounds on the issue. Also it was reported the application of the concept in Public Health with the discussions in literature and the Galway Consensus Conference in 2008.

From knowledge to action in public health management: Experiences from a Norwegian context

Aims: A pro-active approach that incorporates the effective use of scientific evidence and data is a major goal in public health work. This study aimed to identify local and regional strengths and barriers to identify, translate, and use relevant evidence of “what works” in public health management. Methods: Focus group discussions were performed among 22 researchers, public health leaders and/or leaders with organisational and policy responsibilities in two municipalities, one county, and a university research centre. Results: Access to the population’s health data is insufficient for taking action. The focus group discussions clarified a need for a skills programme that specifically focuses on analysis and process expertise. Moreover, communication and collaboration among key stakeholders involved in evidence-based practices like research, policy, and practice should be enhanced in order to facilitate evidence-based policy making. Conclusions: The complex relationship between context and behaviour and the necessity of influencing systems and structures as well as individuals to promote change underlines the need for a clear national initiative to facilitate knowledge exchanges among practitioners, policy makers, and researchers.

Public health skills for a lay workforce: findings on skills and attributes from a qualitative study of lay health worker roles

OBJECTIVES

To present a typology of attributes associated with lay health worker (LHW) roles drawn from a qualitative study of lay roles in the delivery of public health programmes.

STUDY DESIGN

Qualitative research study of case studies of public health projects.

METHODS

Five case studies of public health projects were undertaken, reflecting diverse roles, public health issues and populations. Semi-structured interviews and focus groups were carried out with a sample of 136 stakeholders, including commissioners, practitioners, LHWs and service users. Thematic analysis was conducted within and across cases.

RESULTS

Findings on the pre-eminence of social skills associated with LHW roles were consistent across all five projects. Being approachable, non-judgemental and responsive to community needs were critical attributes that enabled LHWs to undertake outreach and communicate successfully with programme recipients. Experiential knowledge and cultural understanding were also important qualities. A typology of attributes associated with LHW roles is presented.

CONCLUSIONS

Social skills, the ability to connect with a community, and the ability to develop respectful relationships are fundamental qualities for LHW roles. Further research would be required to produce a comprehensive map of LHW skills; however, the paper questions assumptions that lay skills are necessarily of a lower order than the professional skill set.

Progress and Directions in Professional Credentialing for Health Education in the United States

This article provides an update on initiatives in individual certification and accreditation of academic programs in public/community health education and school health education in the United States. Although we provide some historical context, the focus primarily addresses credentialing efforts that have evolved since the Galway Consensus Conference was convened in 2008 and publication of the Galway Consensus and related manuscripts in 2009. Significant progress has been achieved in updating the health education competencies for entry and advanced levels of practice, as well as in establishing a Master Certified Health Education Specialist designation. Also discussed are contemporary initiatives to expand and improve the accreditation process of academic programs and the evolving higher education contexts in which such systems operate. We conclude by presenting lessons learned from the U.S. experience with credentialing efforts and by offering recommendations that may be applicable to future quality assurance efforts, both in the United States and abroad.