“Best practices in health promotion” occur when the processes and activities associated with health-related issues, organization/work-related issues, and research and evaluation reflect criteria and guiding principles representing each of the following domains and subdomains:

¨      health promotion values/goals/ethics

¨      health promotion theories & concepts/underlying beliefs & assumptions

¨      health promotion relevant evidence

¨      a health promotion understanding of the environment

¨      health promotion processes and activities

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PINNINGS

Values

values should:

·  be consistent with and reflect health promotion goals and ethics, theories and beliefs, evidence, understanding of the environment, and practice

·  be identified and defined at individual, team, and organizational levels

·  identify and constructively address areas of agreement/disagreement

·  be reviewed and updated regularly to ensure that they are still appropriate and relevant, and that they are integrated into all aspects of the initiative

Our health promotion values include:

·  health
optimal health for all

·  social justice
equity re. the fair distribution of resources; respect for diversity

·  power sharing
reduction of power differentials; individual and community empowerment; participation by relevant stakeholders in decision making, partnerships, etc.; individual and community capacity development

·  the environment
ecological respect & sensitivity

·  enrichment of individual and community life
authenticity; creativity; critical reflection; joy; meaningfulness; social connectedness

Goals

goals should:

·  be consistent with and reflect health promotion values and ethics, theories and beliefs, evidence, understanding of the environment, and practice

·  be identified in a way that constructively addresses areas of agreement/disagreement

·  be reviewed and updated regularly to ensure that they are still appropriate and relevant, and that they are integrated into all aspects of the initiative

Our health promotion goal is to increase overall levels of:

·  health and well-being of communities and individuals

·  social justice

·  power sharing

·  ecological respect & sensitivity

·  enriched individual and community life

Ethics

ethical principles should:

·  be consistent with and reflect health promotion values and goals, theories and beliefs, evidence, understanding of the environment, and practice

·  be identified and defined on individual, team, and organizational levels

·  be identified in a way that constructively addresses areas of agreement/disagreement

·  be reviewed and updated regularly to ensure that they are still appropriate and relevant, and that they are integrated into all aspects of the initiative

Our health promotion ethical principles include that we will:

·  aim to benefit rather than harm

·  think of the consequences of any action re. whom/what might be harmed or benefited

·  have an explicit decision-making rationale that is consistent with identified values in cases of conflict (i.e., if what would benefit one might harm another)

·  recognize competing ethical considerations and to try to judge these openly, critically and fairly

·  always consider whether any action is the best one (i.e. be constantly reflective and critical)

·  put principles above self-interest

Theories /concepts

theories and concepts should:

·  be consistent with and reflect health promotion values and ethics, theories and beliefs, evidence, understanding of the environment, and practice

·  be identified and defined at individual, team, and organizational levels

·  be identified in a way that constructively addresses areas of agreement/disagreement

·  be drawn from a wide variety of disciplines

·  be appropriate to the level of analysis and intervention—i.e., individual, immediate environments, & social structures

·  be used in an integrated way

·  be used at each stage of the practice—i.e., in planning, implementation & evaluation

·  contribute to understanding the nature and origins of issues/problems

·  contribute to an understanding of how to respond to issues/problems by bringing about positive change

·  evolve according to new insights and/or new evidence

·  be reviewed and updated regularly to ensure that they are still appropriate and relevant, and that they are integrated into all aspects of the initiative

Some of the major theories/concepts used in health promotion for us to draw on include: (extracted from Theory in a Nutshell, Nutbeam & Harris)

·  individual
health belief model; theory of reasoned action (Ajzen & Fishbein); transtheoretical stages of change model (Prochaska & DiClemente); social learning theory (Bandura)

·  community
community mobilisation (a combination of “locality development”, “social planning”, and “social action”); diffusion of innovation theory (Rogers)

·  communication
communication-behaviour change (McGuire); social marketing; intersectoral action model

·  organization
organizational change (Goodman et al.)

·  public policy
ecological framework (Milio); determinants of policy making model (De Leeuw); indicators of policy-making process (Ziglio)

Our descriptions of key health promotion concepts include:

·  health promotion
a set of activities designed to achieve optimal health for all by maintaining and enhancing the health of everyone and facilitating individual & collective control over the determinants of health. Its processes are empowering/capacity-building on both individual and group levels and context-sensitive (that is, taking into consideration culture, specific conditions, etc.). Its main objective is to create supportive environments by making multi-level changes (personal, family, organizational, community, physical environment, society-wide systems). It works with other sectors to achieve its goals and objectives. Its concept of health is holistic (i.e., health includes several interdependent domains, and is determined by a number of socio-political and other factors), positive (it is not only the absence of disease, it is a resource for everyday living), and multi-level (the health of individuals, organizations, communities, and society needs to be considered as the levels interact with each other). Its basic values are health, social justice (equity, respect for diversity), power sharing, the environment, individual/community enrichment; no health promotion strategy works in isolation—each has strengths and weaknesses, and works most effectively in conjunction with other strategies either as an active component or as a support

·  health
a major determinant of quality of life which exists on a continuum ranging from poor to optimal; it can be measured in objective terms (e.g., muscle tone, mental alertness, presence or absence of infection) or in subjective terms (e.g., feeling of being “well” or “healthy”); it extends beyond the physical to include mental, emotional, social, spiritual and other aspects, which are connected; it is affected by a complex interrelationship of many factors including biological, environmental, social, cultural, political, and economic influences, and applies to individuals, communities and populations

·  determinants of health
factors that influence health; they work synergistically on individual, community and societal levels; they include income (i.e., individual income, and the degree of income equity in a society), social status, education, power/control, social cohesion/support, nature of social, political and economic environments, and individual health-related behaviour and resilience; it is important not to ignore the “pre-determinants” (i.e., those factors that determine the nature of the determinants in any society—for example, why a small or large gap exists between the richest and the poorest sectors of a society)

·  achievement of optimal health for all
it is necessary that: all determinants of health be addressed; all aspects of health (i.e., physical, social, emotional, etc.) be taken into account; individuals have as much control over their own lives as possible within a social/community context (requiring an equitable distribution of wealth & resources), have a holistic and open-minded approach to life; the power structure is consistent with health promotion values; those most directly affected by any issue fully participate in relevant decision-making process; relationships are mutually supportive, beneficial, sensitive, and respectful to the greatest extent possible; change that is consistent with health promotion values occur on individual, group and society-wide levels, through both individual & collective action; the means used are consistent with the desired ends

Underlying beliefs /assump
tions

underlying beliefs/assumptions should:

·  be consistent with and reflect health promotion values, goals and ethics, theories, evidence, understanding of the environment, and practice

·  be identified and defined on individual, team, and organizational levels

·  be identified in a way that constructively addresses areas of agreement/disagreement

·  be reviewed and updated regularly to ensure that they are still appropriate and relevant, and that they are integrated into all aspects of the initiative

·  at a minimum, be identified with respect to: health, how society works, how to achieve change (at the individual, organizational, community, societal, etc. levels), how we learn & know, human nature, role of self-interest

Our health promotion underlying beliefs and assumptions include:

·  health
is positive, holistic, multi-level, and strongly influenced by the “determinants” of health

·  how society works
there is a strong interplay between social/system structures and the individual, and it is not possible to say that one is more formative than the other; while structures have a tremendous impact on individuals, individuals contribute to maintaining and changing structures.

·  how to achieve social change
the prerequisites for lasting substantial change are: a critical mass of people who share a common vision/goal; belief that fundamental change can occur; belief that collectively people have the innate wisdom and capacity to identify and resolve their own issues; recognition that change will occur only through an intersectoral effort; effective appropriate leadership; ability to analyze a situation honestly, critically, creatively and open-mindedly; ability to think strategically; ability to work in good ways with each other; ability to act in ways that are consistent with one’s beliefs in all aspects of one’s life

·  how we learn & know
there is an external reality which everyone experiences, interprets differently, but can (within limits) agree upon; people come to learn, know, understand and integrate their worlds into their lives as a result of: their own experiences, explorations and struggles; through interactions with other people—in this way, everyone has expertise and everyone can learn from others

·  human nature
given the right circumstances, the majority of people are basically good; collectively, people have the innate capacity to identify and resolve the issues facing them

·  role of self-interest
ultimately, our true self-interest lies: in working co-operatively, sharing with each other, and supporting each other; emphasizing the intangibles such as friendship, rather than material goods (beyond meeting one’s basic needs for food and shelter)

Evidence

re. the foundations of evidence, evidence should be:

·  consistent with and reflect health promotion values, goals, ethics, theories, underlying beliefs, understanding of the environment, and practice

·  identified and defined on individual, team, and organizational levels

·  be identified in a way that constructively addresses areas of agreement/disagreement

re. the sources of evidence, evidence should:

·  be derived from sources that include all key stakeholders and relevant key informants

·  be drawn from sources internal and external to the particular initiative

·  include results/outcomes related to past and current practice

·  collect data using a combination of quantitative and qualitative methods

re. the nature of evidence, evidence should:

·  transcend information supporting conventional wisdom (i.e., include information supporting new or non-mainstream ideas as well as information contradicting generally accepted ideas)

·  be high quality (i.e., based on accurate data, produced by methods appropriate to the question, includes processes to outcomes, uses both quantitative and qualitative perspectives)

·  be qualitative and quantitative, subjective and objective—used in a complementary fashion

·  be appropriate to the specific issue, setting, etc.

·  include the relationship between results/outcomes and processes

re. the use of evidence, evidence should:

·  be used at each stage of practice (i.e., planning, implementation, evaluation, redesigning)

·  contribute to continuous learning and knowledge development—that is lead to (a) a broad and complete picture of what is happening, (b) insights into why things happen, and (c) how we might make things happen differently

·  be reviewed and updated regularly to ensure that it is still appropriate and relevant, and that it is integrated into all aspects of the initiative

·  be used with awareness, clarity, and reflection regarding all factors relevant to decision-making about health promotion practice

·  be used to evaluate the processes and outcomes of our initiative on a regular basis

·  be used to follow up on the evaluation results and recommendations

not applicable (varies with the specific issue/situation)

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STANDING OF THE ENVIRONMENT

Vision

vision of the organization/work- and health-related environments should:

·  be consistent with and reflect health promotion values, goals and ethics, theories and beliefs, evidence, analysis of the environment, and practice

·  be identified and defined on individual, team, and organizational levels

·  be identified in a way that constructively addresses areas of agreement/disagreement

·  be reviewed and updated regularly to ensure that it is still appropriate & relevant, and that it is integrated into all aspects of the initiative

Our health promotion vision of our environment includes:

·  emphasis on a team approach¾life/work tasks are done cooperatively in an atmosphere of trust

·  clearly defined roles and responsibilities, policies, processes, procedures

·  effective leadership and management along with appropriate and effective accountability

·  reasonable expectations

·  respect for individuals and groups

·  power acknowledged and shared as much as possible in order to reduce power differentials (e.g. through knowledge/skill sharing and a decision making structure that promotes power-sharing in an appropriate way)

·  recognition, appreciation and use of individual and collective capacities, with recognition given to “natural” sources of capacities (such as innate gifts, experience, skills, knowledge)

·  adequate resources (including time), and appropriate, effective, and efficient use of available resources

·  resources shared on the basis of need

·  respect for ecosystem

·  motivation for the common good rather than for individual/corporate profit

·  critical/constructive thinking, with openness to new ideas and ways of doing things, constructive problem solving, and ongoing evaluation & reflection & learning

·  fulfilling and satisfying work

·  good physical & psychological working & living conditions including social support, manageable stress levels, and pleasure and joy

·  recognition that process and outcomes are integrally related and both are important

Analysis of organiza
tion/work- and health-related issues

analysis of organization/work- and health-related issues should identify:

·  priority issues

·  which priority issue to address immediately

·  relationship of selected issue to health and/or to the organization/work

·  the environments within which the selected issue exists with respect to: social, political, and economic systems and structures; psychological and physical conditions

·  the etiology of the selected issue

·  existing/potential capacities and challenges related to influencing the selected issue

·  ways to make use of/enhance current/potential capacities and to address current/potential challenges

·  ways to positively influence the selected issue

analysis of the organization/work- and health-related environments should:

·  be consistent with and reflect health promotion values, goals and ethics, theories and beliefs, evidence, vision, and practice

·  be identified and defined on individual, team, and organizational levels

·  be identified in a way that constructively addresses areas of agreement/disagreement

·  be reviewed and updated regularly to ensure that it is still appropriate & relevant, and that it is integrated into all aspects of the initiative

selection of issue should:

·  be based upon appropriate participation by relevant stakeholders

·  reflect the influence of the broader determinants of health (including their structural origins)

·  give attention to power-related issues and the potential role of empowering strategies