Competências em promoção da saúde: uma análise conceitual

I always read with interest any nursing article that professes to deal with health promotion and this was no less so with Irvine’s recent article regarding ‘health promotion’ competencies as they relate to the discipline of district nursing. It is timely that more nursing-specific articles are addressing what they perceive to be health promotion issues – even if it is not actually health promotion that they are really addressing. Irvine’s article is no exception to the emerging tide of recent nursing-specific literature that is conceptually confused when it comes to health promotion activity. This is not a major problem, at this juncture, because such articles serve as a useful springboard to rectify the situation by allowing the real context and location of health promotion to surface through debate such as this. Where it becomes a problem, however, is if, in the face of the established position of health promotion in today’s context, nursing continues to disregard later perspectives in favour of ‘old-guard’ regimes and practices. I have been one of those who particularly seek to champion the real ‘new’ context of health promotion (which actually is not that new anymore) in the hope of moving things on for health-related activity in nursing (i.e. Whitehead 2001, 2003a,c, 2004, 2005). What Irvine (2005) refers to in her article as the ‘new paradigm’ of health promotion and her additional use of the term ‘traditional health promotion’ are very much out-of-date and outmoded concepts. She uses Maben and Macleod-Clark’s (1995) concept analysis as a basis for her interpretation of health promotion as it pertains to the study’s highlighted competencies. As we can already see this article is a decade old and has been both critiqued and superseded by a more recent concept analysis, that identifies current health promotion process in its much broader context of socio-political process, overall population health strategy and ‘whole’ community empowerment (Whitehead 2004). This type of activity is now inherent in the majority of mainstream health promotion literature – and what nursing should be striving to reflect in its health promotion activity. What Irvine (2005) is really referring to in her article is the notion of health education competencies as they relate to district nursing practice – not health promotion. There are different levels of health education practice and, admittedly, some of those highlighted in Irvine’s article do refer to less limiting health education techniques – namely those that acknowledge the contribution of individual empowerment, community presence and political awareness – what I would refer to as the ‘education’ component of health education practice (Whitehead 2004, Whitehead & Russell 2004). There is, however, a huge gap between community presence and ‘community empowerment’ and the same is true for the difference between political awareness and being ‘politically active’ – both, which are a mainstay of current health promotion activity. Irvine’s study mainly identifies the district nursing competencies of disease process, ill health, opportunism, lifestyle and behaviour-change, psychomotor, cognitive and affective activity and epidemiology – which are very much entrenched within conventional and traditional approaches to health education. Irvine has demonstrated just how easy it is for nursing to fall into the trap of contextually confusing our practices and failing to move forward from current locations. Downie et al. (1996, p. 12) have described this phenomenon stating that:

O desenvolvimento de competências na formação dos profissionais de saúde tem sido discutido na literatura científica como forma de assegurar serviços de qualidade e foi tema recente de publicações importantes no cenário internacional. No entanto, o Brasil apresenta poucas experiências e produções sobre o tema. O estudo teve como objetivo analisar como são configuradas as competências para a promoção da saúde na formação do enfermeiro. Trata‑se de revisão integrativa da literatura, na qual foram incluídos oito artigos, teses e dissertações publicados a partir do ano 2000 em inglês, espanhol e português. Os descritores utilizados para a busca foram: “promoção da saúde”, “educação baseada em competências” e “competência profissional”. A análise permitiu revelar as seguintes categorias temáticas: definição de competências, competências e promoção da saúde e ensino das competências em promoção da saúde. Os achados mostram que a maior parte da literatura é de origem internacional. A maioria guarda semelhança com as competências do CompHP e Consenso de Galway e apresentam a definição de competência como a combinação de três domínios: atitude, conhecimento e habilidades. A promoção da saúde é abordada em disciplinas como saúde pública, saúde da população e políticas de saúde. Evidencia‑se que alunos vivenciam a experiência da promoção da saúde na comunidade. Ademais, a abordagem da promoção da saúde nos anos finais do curso é indicada como mais proveitosa que no início, pela maturidade (clínica e política) dos estudantes.

This study was designed to investigate what type of models, techniques and data are necessary to support the development of a decision support system for health promotion practice in nursing. Specifically, the research explored how interview data can be interpreted in terms of Concept Networks and Bayesian Networks, both of which provide formal methods for describing the dependencies between factors or variables in the context of decision-making in health promotion. In nursing, the lack of generally accepted examples or guidelines by which to implement or evaluate health promotion practice is a challenge. Major gaps have been identified between health promotion rhetoric and practice and there is a need for health promotion to be presented in ways that make its attitudes and practices more easily understood. New tools, paradigms and techniques to encourage the practice of health promotion would appear to be beneficial. Concept Networks and Bayesian Networks are techniques that may assist the research team to understand and explicate health promotion more specifically and formally than has been the case, so that it may more readily be integrated into nursing practice. As the ultimate goal of the study was to investigate ways to use the techniques described above, it was necessary to first generate data as text. Textual descriptions of health promotion in nursing were derived from in-depth qualitative interviews with nurses nominated by their peers as expert health promoting practitioners. The nurses in this study gave only general and somewhat vague outlines of the concepts and ideas that guided their practice. These data were compared with descriptions from various sources that describe health promotion practices in nursing, then examples of a Conceptual Network and a representative Bayesian Network were derived from the data. The study highlighted the difficulty in describing health promotion practice, even among nurses recognized for their expertise in health promotion. Nevertheless, it indicated the data collection and analysis methods necessary to explicate the cognitive processes of health promotion and highlighted the benefits of using formal conceptualization techniques to improve health promotion practice.

A qualitative study exploring the relationship between nursing and health promotion language, theory and practice

Projects in Australia and internationally over the past two decades have sought to define and clarify competencies required to work in health promotion. It is now apparent that such competencies are very useful to health promotion practice. However, to date little attempt has been made to describe those uses. More than 200 health promotion practitioners throughout Australia were engaged in workshops to explore and define potential uses of health promotion competencies. The suggestions from these 10 workshops are summarised in eight categories of uses. Agreed health promotion competencies have potential to impact on recruitment, training, employment policy and health promotion practice.

SummaryIntroductionHealth promotion is an integral part of routine clinical practice. The physicians’ role in improving the health status of the general population, through effective understanding and delivery of health promotion practice, is evident throughout the international literature. Data from India suggest that physicians have limited skills in delivering specific health promotion services. However, the data available on this is scarce. This study was planned to document the current health promotion knowledge, perception and practices of local primary care physicians in Odisha.MethodsAn exploratory study was planned between the months of January – February 2013 in Odisha among primary care physicians working in government set up. This exploratory study was conducted, using a two-step self-administered questionnaire, thirty physicians practicing under government health system were asked to map their ideal and current health promotion practice, and potential health promotion elements to be worked upon to enhance the practice.ResultsThe study recorded a significant difference between the mean of current and ideal health promotion practices. The study reported that physicians want to increase their practice on health education.ConclusionWe concluded that inclusion of health promotion practices in routine care is imperative for a strong healthcare system. It should be incorporated as a structured health promotion module in medical curriculum as well.

Clinical Preventive Medicine in Primary Care: Background and Practice: 1. Rationale and Current Preventive Practices

BackgroundDuring the last two decades there has been a call for physiotherapists (PTs) to increase health promotion (HP) interventions in their practice to optimize health and well-being. However, little is known about the characteristics of such practices. The aim of this study was to provide an in-depth examination of the experiences of Colombian PTs regarding their HP practices in chronic health conditions and lifestyle related risk factors.MethodsAn interpretive description qualitative approach was used to explore the experiences and perspectives of Colombian PTs in HP. Semi-structured interviews were conducted with a purposive sample of PTs. Thematic analysis was conducted with the assistance of NVivo software.ResultsTwelve participants were interviewed. We found three main themes: navigating the health system, current physiotherapists’ health promotion practices; and improving health promotion practice. Participants described restrictions to HP practice due to various systemic barriers and lack of autonomy as well as the insufficient recognition of the role of PTs in this field. Participants recognized the important role of HP in health and wellbeing and how their perception of HP has evolved throughout their careers. They also considered they are the ideal professionals to lead HP programs related to chronic conditions and associated lifestyle risk factors. However, they felt they needed more education and skills, placing the responsibility for this, as well as advocacy for recognizing their role in this field, on professional associations and academia.ConclusionsThe practice of HP in physiotherapy is hindered by the lack of recognition of their potential in this area and the barriers imposed by the health system. It is necessary to explore ways to enhance the recognition of the role of PTs in HP and the development of HP skills.Key messages• The characteristics of the health system shape health promotion practices in physiotherapy regarding chronic conditions and related lifestyle risk factors.• More education and awareness of the potential role of PTs in HP in chronic conditions is needed.

This chapter will discuss factors influencing the value of health education and health promotion in general dental practice. Four key areas are reviewed, namely: the role that general dental practice could play in health education and health promotion; criticisms of the current practice of health education in general dental practice; the role of chairside health education and health education materials in general dental practice; developing an oral health promotion strategy for general dental practice.

BACKGROUND Health education and promotion are recognized as effective strategies for fostering healthy ageing, reducing the disease burden, and addressing health inequalities, particularly when delivered through digital media. Primary care workers are often regarded as the key providers of these interventions. Despite the strong practical significance and substantial individual demand, the use of digital media for delivering health promotion practices was not widespread in China. One of the main challenges identified is the providers’ inadequate capacities. However, little is known about the digital capacity for health promotion among primary care workers. OBJECTIVE This study aimed to investigate the levels of digital capacity for health promotion and its associated factors among community health workers. METHODS A total of 1346 community health workers were recruited from across 47 communities in Shanghai, China, through cluster-stratified random sampling. The digital capacity for health promotion was measured using the revised version of the Digital Capabilities Framework. Web-based questionnaires were distributed to collect data from March 20 to March 29, 2024. Data were analyzed using descriptive statistics, independent t tests, one-way ANOVA, and linear hierarchical regression using Stata MP (version 17.0; StataCorp). RESULTS We included 1199 participants. Among them, 47.5% (570/1199) had high digital media use for more than 19.6 hours per week, whereas 31.8% (381/1199) demonstrated high digital media trust. The average level of digital capacity for health promotion was 16.71 (SD 2.94) out of 25 points. Demographics, digital media usage–related characteristics, perceived usefulness and usability, attitudes, and behaviors were significant predictors of the capacities, explaining 44.4% of the total variance. Master’s degree or above (β=.077; <i>P</i>=.013), perceived usability (β=.235; <i>P</i><.001), attitudes toward digital media health promotion (β=.095; <i>P</i>=.002), and past digital media health promotion practices (β=.377; <i>P</i><.001) had significantly positive associations with digital capacities for health promotion. However, senior (β=–.076; <i>P</i>=.008) or median (β=–.074; <i>P</i>=.01) titles had a significant negative association with capacity levels. CONCLUSIONS A digitally capable workforce is required for primary health care systems to take full advantage of digital media health promotion. Therefore, solutions are necessary to achieve enhanced capacities among health professionals, including public health policy making, community empowerment, and individual practices.

This paper examines recent Australian health reform policies and considers how the primary health care (PHC) workforce experiences subsequent change and perceives its impact on health promotion practice. Health policy documents were analysed to determine their intended impact on health promotion. Interviews were conducted with 39 respondents from four State-funded PHC services to gain their perceptions of the impact of policy change on health promotion. There have been a plethora of policy and strategy documents over the last decade relevant to PHC, and these suggest an intention to strengthen health promotion. However, respondents report that changes to the role and focus of PHC services have led to fewer opportunities for health promotion. Services are struggling to engage in health promotion activity, while funding and policy directions are prioritised to targeted, individual behaviour change. The experience of PHC workforce respondents in South Australia suggests that, despite policy intentions, health promotion practice is much reduced. Our research suggests that rigorous evaluation of health sector reforms should be undertaken to assess both intended and unintended outcomes in terms of service quality and delivery. SO WHAT? Health promoters are experiencing a contradictory policy and practice environment, and this research should assist health promoters in advocating for more government accountability in the implementation of policies in order to advance comprehensive PHC.

The aim of this paper is to evaluate changes in organizational capacity and sport-related health promotion policies and practices among State Sporting Organizations (SSOs) who participated in the Partnership for Health (PfH) scheme. The PfH scheme aimed to support the development and implementation of sport-related health promotion policies and practices at SSO-organized events and within their affiliated sports clubs. SSO representatives completed the Health Promotion and Sport Assessment Tool (HP-SAT) twice. Respondents reported capacities, policies, and practices prior to the scheme (retrospective pre-scheme survey), and current capacities, policies, and practices (post-scheme survey). The mean scores (on standardized scales: 0–100) for all components of organizational capacity for health promotion increased significantly between pre-scheme and post-scheme. Similarly, compliance scores for most sport-related health promotion policies and practices for SSO-organized events and support to clubs increased significantly. However, post-scheme strategic planning for health promotion remained low and scores for policies and practices for clubs were generally lower than for SSO-organized events. No significant differences were found between small and large SSOs regarding capacities, policies, or practices. The PfH scheme had a positive impact on most aspects of health promotion capacities, policies, and practices. However, there was room for further improvement in strategic planning and in support for affiliated clubs. Low levels of strategic planning should be addressed by SSOs, and a more extensive engagement between SSOs and affiliated clubs is required to operationalize health promotion strategies at club level.

Association of health professional leadership behaviors on health promotion practice beliefs


 The article identifies health promotion activities for the oldest people, who often become users of social services due to loss of capabilities, solitude and raising care needs related to worsening health status. The analysis is based on the literature overview, experts’ consultations and interviews on the role of the social sector institutions in health promotion in selected countries. Examples of best practices in health promotion for older people in the social sector are presented. These include programmes of health information and campaigns on health risks avoidance, stimulation of physical activity, healthy eating for the oldest seniors, promotion of mental health and support of cognitive abilities, primary prevention activities and stimulation of social and cultural participation. The article concludes that health promotion activities for the oldest population, although on the side of main activities of the social sector, are an important element of activities of public and non-public institutions in providing care to dependent populations. Good practices identified typically involve numerous health promotion activities and require cooperation at the national – policy setting – level and within community.
 
 The article identifies health promotion activities for the oldest people, who often become users of social services due to loss of capabilities, solitude and raising care needs related to worsening health status. The analysis is based on the literature overview, experts’ consultations and interviews on the role of the social sector institutions in health promotion in selected countries. Examples of best practices in health promotion for older people in the social sector are presented. These include programmes of health information and campaigns on health risks avoidance, stimulation of physical activity, healthy eating for the oldest seniors, promotion of mental health and support of cognitive abilities, primary prevention activities and stimulation of social and cultural participation. The article concludes that health promotion activities for the oldest population, although on the side of main activities of the social sector, are an important element of activities of public and non-public institutions in providing care to dependent populations. Good practices identified typically involve numerous health promotion activities and require cooperation at the national – policy setting – level and within community. 
 

Socio-cultural factors negate the health of women. Therefore, health promotion as a focus of nursing practice aimed at capitalizing on the inherent capacities of women to establish health priorities, goals and strategies to improve their health. A descriptive survey with the purpose of ascertaining the influence of culture, social and health policies on nurses’ practice of health promotion was undertaken. Three hypotheses were formulated to guide the study. A sample of one hundred and thirty six nurses participated in the study. A validated questionnaire with a test-retest reliability coefficient (r) of 0.79 was used for data collection. Correlation analysis was carried out to test hypotheses. The results revealed that 132 (97.1%) participants were female with a mean (SD) age of 40 ± 7.29. Many participants 58 (42.6%) perceived that social policies have high influence on their practice of health promotion. The results also showed significant negative correlation between culture and practice of health promotion (r = -0.532; p = 0.01) while the practice of health promotion was significantly and positively correlated with social policies (r = 0.515; p = 0.01). It was recommended that negative cultural practices be addressed through social policies and health education of women on negative cultural practices in order to enhance the practice of health promotion for them.   Key words: Culture, health policy, health promotion, nursing practice of health promotion for women, social policies.