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Echoing the rise of 'evidence-based medicine' the concept of evidence-based policy and practice in the inter-related fields of health promotion, public health and health improvement has attracted increasing attention over the past two decades. More recently, again with roots traceable to biomedical thinking, there has been growing interest in ethics in relation to these fields. This paper links these two topical themes in a practical way. It explores the extent to which policies and activities 'on the ground' can and should be based on evidence, and considers the relative places of evidence and ethics in decision-making. It goes on to present the 'decision-making triangle' a framework that gives primacy to a set of ethical principles ― with available evidence and plausible theory being used to inform the application of these. After introducing the concept of 'ethical logic modelling' the paper concludes by suggesting an 'ethical imperative' for health promotion, public health and health improvement: to make decisions based on the explicit application of ethical principles, using available evidence and theory appropriately. [ABSTRACT FROM AUTHOR]

In this paper, we analyse Canadian health promotion discourse past and present, in the context of selected federal and provincial government policy initiatives. Principally, we examine the health promotion discourse articulated in A New Perspective on the Health of Canadians, Achieving Health for All: A Framework for Health Promotion, the Ottawa Charter for Health Promotion, Improving the Health of Canadians, and Canada Health Action: Building on the Legacy-Volume II-Synthesis reports and Issue papers. We argue that the health promotion lessons of the past 30 years contained within these reports have largely been forgotten, overlooked or disregarded in policy implementation. We conclude, as have many before us, that successful health promotion policy needs to reflect a collectivist rather than individualist ethos where responsibility for the health of Canadians is concerned. Moreover, it needs to be one that addresses the social determinants of health, including inequity, via the coordination of healthy public policy. [ABSTRACT FROM AUTHOR]

Governments and other public health agencies have become increasingly interested in evidence-informed policy and practice. Translating research evidence into programmatic change has proved challenging and the evidence around how to effectively promote and facilitate this process is still relatively limited. This paper presents the findings from an evaluation of a series of evidence-based health promotion resources commissioned by the Victorian Department of Human Services. The evaluation used qualitative methods to explore how practitioners for whom the resources were intended, viewed and used them. Document and literature review and analysis, and a series of key informant interviews and focus groups were conducted. The findings clearly demonstrate that the resources are unlikely to act as agents for change unless they are linked to a knowledge management process that includes practitioner engagement. This paper also considers the potential role of knowledge brokers in helping to identify and translate evidence into practice. [ABSTRACT FROM AUTHOR]

In the past few years, significant advances have been made in health promotion to generate readily accessible systematic reviews of evidence on the effectiveness of interventions and programs. The influence of this evidence on policy and practice has, however, been unpredictable, and proponents of evidence-based practice are identifying ways to increase the use of research in decisions about health promotion interventions. This paper examines the following questions: (i) is the evidence that is available on the effectiveness of interventions actually relevant and useful to current policy and practice contexts?; and (ii) what is the researcher's or reviewer's role in interpreting the available evidence and advocating action based on their interpretations? The paper concludes by proposing an ‘evidence-agenda map’ to assist advocates of evidence-based policy and practice to identify the health promotion goals they seek to influence against the required and available evidence. [ABSTRACT FROM AUTHOR]

This paper reports on a research study into the professional interface between health promotion and complementary and alternative medicine. The study was conducted in the UK, the USA and, to a lesser extent, Eastern Europe. Professionals from both sides of the interface were interviewed. The findings suggest that health promoters committed to individual empowerment and community action are the most likely to support some form of involvement with complementary and alternative medicine, while the least likely are those committed to structural changes through a public health agenda. The paper identifies the potential for closer integration but also reports on substantial barriers to collaboration between these two professional groups. [ABSTRACT FROM AUTHOR]

This paper discusses the design of a methodology for 'building capable communities' in a health promotion programme context. The design of the methodology builds upon previous work and offers a new approach, through the use of nine 'operational domains', for the assessment and strategic planning of community empowerment. The purpose is to go beyond the rhetoric of participation and empowerment, and to provide a better understanding of how community empowerment goals can be made to be operational in a health promotion programme context. The experiences of implementing the methodology in two rural Fijian communities are discussed briefly. The common themes for the successful application of the methodology have been identified. The paper will be of interest to the planners and evaluators of health promotion programmes that aim to build community capacity and promote empowerment. [ABSTRACT FROM AUTHOR]

This paper presents data from 40 in-depth interviews that were conducted as part of a study of social capital and health in relation to people's perceptions of the influence of 'place' on their participation levels and health. These data were used to examine features of the western suburbs of Adelaide that were perceived as health damaging and health promoting. The paper demonstrates that our Australian suburban respondents expressed a considerable concern about these features and the impact they have on their perception of community and their ability to participate in it. Safety, connectedness to the area, the reputation of an area and the extent and nature of community facilities are all seen as important to a healthy community. The research found that in the more deprived socioeconomic areas within the study are, there was a significant degree of dissatisfaction with features of the urban environment, such as availability of amenities, provision of public transport, and proximity of industry to private dwellings. The paper concludes by considering certain features of urban environments that might make them more supportive of health through encouraging contact between people. We conclude that these environments could be improved using the following measures: a subsidy scheme to support the viability of local shops and cafés (thereby providing meeting places and employment): parks with facilitators (who could play a role in increasing safety in the park but also encouraging community development): attractive places to walk: and a general environmental improvement program. [ABSTRACT FROM AUTHOR]

The 1997 Jakarta Declaration on Health Promotion into the 21st Century called for new responses to address the emerging threats to health. The declaration placed a high priority on promoting social responsibility for health, and it identified equity-focused health impact assessment as a high priority for action. This theme was among the foci at the 2000 Fifth Global Conference on Health Promotion held in Mexico. This paper, which is an abbreviation of a technical report prepared for the Mexico conference, advances arguments for focusing on health impact assessment at the local level. Health impact assessment identifies negative health impacts that call for policy responses, and identifies and encourages practices and policies that promote health. Health impact assessment may be highly technical and require sophisticated technology and expertise. But if can also be a simple, highly practical process, accessible to ordinary people, and one that helps a community come to grips with local circumstances that need changing for better health. To illustrate the possibilities, this paper presents a case study, the People Assessing Their Health (PATH) project from Eastern Nova Scotia, Canada. It places ordinary citizens, rather than community elites, at the very heart of local decision-making. Evidence from PATH demonstrates that low technology health impact assessment, done by and for local people, can shift thinking beyond the illness problems of individuals. It can bring into consideration, instead, how programmes and policies support or weaken community health, and illuminate a community's capacity to improve local circumstances for better health. This stands in contrast to evidence that high/v technological approaches to community-level health impact assessment can be self-defeating. Further development of simple. people-centred, low technology approaches to health impact assessment at the local level is called for. [ABSTRACT FROM AUTHOR]

Over the past 20 years, the federal government and universities across Canada have directed resources towards the development of university-based health promotion research centres. Researchers at health promotion research centres in Canada have produced peer-reviewed papers and policy documents based on their work, but no publications have emerged that focus on the specific roles of the health promotion research centres themselves. The purpose of this paper is to propose a framework, based on an in-depth examination of one centre, to help identify the unique roles of health promotion research centres and to clarify the value they add to promoting health and advancing university goals. Considering the shifting federal discourse on health promotion over time and the vulnerability of social and health sciences to changes in research funding priorities, health promotion research centres in Canada and elsewhere may need to articulate their unique roles and contributions in order to maintain a critical focus on health promotion research. The authors briefly describe the Atlantic Health Promotion Research Centre (AHPRC), propose a framework that illustrates six essential roles of health promotion research centres and describe the policy contexts and challenges of health promotion research centres. The analysis of research and knowledge translation activities over 15 years at AHPRC sheds light on the roles that health promotion research centres play in applied research. The conclusion raises questions regarding the value of university-based research centres and challenges to their sustainability. [ABSTRACT FROM AUTHOR]

Women and men are different as regards their biology, the roles and responsibilities that society assigns to them and their position in the family and community. These factors have a great influence on causes, consequences and management of diseases and ill-health and on the efficacy of health promotion policies and programmes. This is confirmed by evidence on male–female differences in cause-specific mortality and morbidity and exposure to risk factors. Health promoting interventions aimed at ensuring safe and supportive environments, healthy living conditions and lifestyles, community involvement and participation, access to essential facilities and to social and health services need to address these differences between women and men, boys and girls in an equitable manner in order to be effective. The aim of this paper is to (i) demonstrate that health promotion policies that take women's and men's differential biological and social vulnerability to health risks and the unequal power relationships between the sexes into account are more likely to be successful and effective compared to policies that are not concerned with such differences, and (ii) discuss what is required to build a multisectoral policy response to gender inequities in health through health promotion and disease prevention. The requirements discussed in the paper include i) the establishment of joint commitment for policy within society through setting objectives related to gender equality and equity in health as well as health promotion, ii) an assessment and analysis of gender inequalities affecting health and determinants of health, iii) the actions needed to tackle the main determinants of those inequalities and iv) documentation and dissemination of effective and gender sensitive policy interventions to promote health. In the discussion of these key policy elements, we use illustrative examples of good practices from different countries around the world. [ABSTRACT FROM PUBLISHER]

This paper highlights the importance of understanding management theories to development of the settings approach to health promotion. It then provides an overview of two areas of especial pertinence: organization development and systems thinking. This is followed by the articulation of the Healthy Living and Working Model, which is proposed as a mechanism for applying the principles of the settings approach in practice within organizations. The paper concludes by pointing to future challenges in developing this Model and reiterating that facilitating improvement at the organizational level should be the defining characteristic of the settings approach to health promotion. [ABSTRACT FROM AUTHOR]

There is extensive evidence that health promotion routinely benefits those who are already most socioeconomically advantaged. While the government's healthy ageing policy recognizes that improving health outcomes will require a range of strategies involving different target groups, recommendations focus on the issues and needs of the comfortable majority. This paper examines the scope and relevance of health promotion for one disadvantaged minority with extensive health needs: homeless older men. In an ethnographic study of older men (⩾ 50 years of age) living alone in the inner city (Sydney), 32 men were identified as homeless and are the focus of this paper. Face to face semi-structured interviews were used to record the men's accounts of their everyday lives, including their health and use of services. The conditions in which these men were living were observed and recorded, and the researchers were aware of health and other services available in the geographic area. All informants were living on or below the poverty line. They reported a range of health conditions, for which many accessed available mainstream and specialist health services. Some obstacles to accessing services were noted. Information relevant to widely endorsed prescriptions for ‘healthy ageing’ also emerged. These included physical activity (especially walking), healthy eating, social activity and adopting healthy lifestyle habits. Findings highlight the extent to which these men lack the basic requirements for healthy ageing, notably adequate incomes and housing. At the same time, within the constraints of the lifestyle they lead, they are motivated to maintain their health and independence. While there are limits to what can be achieved for such people at a local level of service delivery, it is possible to identify feasible health promotion goals and service strategies. [ABSTRACT FROM AUTHOR]

Over the past 10 years, 'settings' based health promotion has become a central feature of efforts to promote health that recognize the significance of context. Emerging in part from a perception of an over-reliance on individualistic methods, the approach was built on a profound belief in its value and deployed a range of novel theoretical resources, mainly from organizational sociology and psychology. This initial enthusiasm has been maintained within policy directives, in the published literature and, from our own experience, amongst health promotion practitioners. At the same time, with the maturing of the approach, has come a healthy element of critical review. Drawing upon the literature and based upon our experiences within the Health Education Board for Scotland, this paper seeks to bring together a range of perspectives, casting a critical yet constructive eye on current settings theory and practice. The paper first reviews the nature of settings based work, high-lighting the varied bases and expectations that underpin it. Similarly, the many factors that influence the ability of health promoters to deliver such activities are considered. In relation to the construction and delivery of such activity, the paper suggests that there needs to be an explicit and detailed assessment of the nature of the setting, the skills of the health promoter and the associated expectations. [ABSTRACT FROM AUTHOR]

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

Community-based interventions are an important component of obesity prevention efforts. The literature provides little guidance on priority-setting for obesity prevention in communities, especially for socially and culturally diverse populations. This paper reports on the process of developing prioritized, community-participatory action plans for obesity prevention projects in children and adolescents using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. We combined stakeholder engagement processes, the ANGELO Framework (scans for environmental barriers, targeted behaviours, gaps in skills and knowledge) and workshops with key stakeholders to create action plans for six diverse obesity prevention projects in Australia (n = 3), New Zealand, Fiji and Tonga from 2002 to 2005. Some sites included sociocultural contextual analyses in the environmental scans. Target groups were under-5-year-olds (Australia), 4–12-year-olds (Australia) and 13–18-year-olds (all four countries). Over 120 potential behavioural, knowledge, skill and environmental elements were identified for prioritization leading into each 2-day workshop. Many elements were common across the diverse cultural communities; however, several unique sociocultural elements emerged in some cultural groups which informed their action plans. Youth were actively engaged in adolescent projects, allowing their needs to be incorporated into the action plans initiating the process of ownership. A common structure for the action plan promoted efficiencies in the process while allowing for community creativity and innovation. The ANGELO is a flexible and efficient way of achieving an agreed plan for obesity prevention with diverse communities. It is responsive to community needs, combines local and international knowledge and creates stakeholder ownership of the action plan. [ABSTRACT FROM PUBLISHER]

Despite the proposed ecological and systems-based perspectives of the settings-based approach to health promotion, most initiatives have tended to overlook the fundamental nature of ecosystems. This paper responds to this oversight by proposing an explicit re-integration of ecosystems within the healthy settings approach. We make this case by focusing on water as an integrating unit of analysis. Water, on which all life depends, is not only an integral consideration for the existing healthy settings (schools, hospitals, workplaces) but also highlights the ecosystem context of health and sustainability. A focus on catchments (also know as watersheds and river basins) exemplifies the scaled and upstream/downstream nature of ecosystems and draws into sharp focus the cross-sectoral and transdisciplinary context of the social and environ- mental determinants of health. We position this work in relation to the converging agendas of health promotion and ecosystem management at the local, regional and global scales-and draw on evidence from international initiatives as diverse as the WHO Commission on Social Determinants of Health, and the Millennium Ecosystem Assessment. Using water as a vehicle for understanding the systemic context for human wellbeing, health promotion and disease prevention draws inevitable attention to key challenges of scale, intersectoral governance and the complementary themes of promoting resilience and preventing vulnerability. We conclude by highlighting the importance of building individual and institutional capacity for this kind of integration-equipping a new generation of researchers, practitioners and decision- makers to be conversant with the language of ecosystems, capable of systemic thought and focused on settings that can promote both health and sustainability. [ABSTRACT FROM AUTHOR]

In 2007, the World Health Organization, together with United Nations and international organization as well as experts, met to draw upon existing evidence and practical experience from regions, countries and individual schools in promoting health through schools. The goal of the meeting was to identify current and emerging global factors affecting schools, and to help them respond more effectively to health, education and development opportunities. At the meeting, a Statement was developed describing effective approaches and strategies that can be adopted by schools to promote health, education and development. Five key challenges were identified. These described the need to continue building evidence and capturing practical experience in school health; the importance of improving implementation processes to ensure optimal transfer of evidence into practice; the need to alleviating social and economic disadvantage in access to and successful completion of school education; the opportunity to harness media influences for positive benefit, and the continuing challenge to improve partnerships among different sectors and organizations. The participants also identified a range of actions needed to respond to these challenges, highlighting the need for action by local school communities, governments and international organizations to invest in quality education, and to increase participation of children and young people in school education. This paper describes the rationale for and process of the meeting and the development of the Statement and outlines some of the most immediate efforts made to implement the actions identified in the Statement. It also suggests further joint actions required for the implementation of the Statement. [ABSTRACT FROM AUTHOR]

Data from the European School Survey Project on Alcohol and other Drugs have shown that adolescent sub- stance use is a growing problem in western and particularly Eastern European countries. This paper describes the development, implementation and results of the Icelandic Model of Adolescent Substance Use Prevention. The Icelandic Model is a theoretically grounded, evidence-based approach to community adolescent substance use prevention that has grown Out of collaboration between policy makers, behavioural scientists, field-based practitioners and community residents in Iceland. The intervention focuses on reducing known risk factors for substance use, while strengthening a broad range of parental, school and community protective factors. Annual cross-sectional surveys demonstrate the impact of the intervention on substance use among the population of 14- to 16-year-old Icelandic adolescents. The annual data from two cohorts of over 7000 adolescents (>81% response rate) show that the proportions of those who reported being drunk during the last 30 days, smoking one cigarette or more per day and having tried hashish once all declined steadily from 1997 to 2007. The pro- portions of adolescents who reported spending time with their parents and that their parents knew with whom they were spending their time increased substantially. Other community protective factors also showed positive changes. Although these data suggest that this adolescent substance use prevention approach successfully strengthened a broad range of parental, school and community protective factors, the evidence of its impact on reducing substance use needs to be considered in light of the correlational data on which these observations are based. [ABSTRACT FROM AUTHOR]

The field of men's health has grown markedly over the past few decades. Increased activity specifically relating to men's health promotion in both Australia and the UK has been noted during this period. There has, however, been a reticence to critically examine men's health promotion work within a broader discourse relating to gender and gender relations. Indeed, the vast majority of health-related gender discussion to date has been focused on women's health experiences and their health practices. In this paper, we argue that grounding men's health within this broad gender discourse is important for building an evidence base in, and advancing, men's health promotion work at a range of levels. We specifically explore the research, practice and policy contexts relating to men's health in Australia and the UK, and describe the facilitators for, and barriers to, promoting men's health. We conclude by suggesting that a critical gender lens ought to be applied to current men's health promotion work and provide strategies for researchers, practitioners and policy makers to move towards this new frontier. [ABSTRACT FROM AUTHOR]

Twenty years have passed since the philosophy and principals were formulated in the Ottawa Charter for health promotion. A critical reflection of the content and success of the Ottawa Charter was published before the IUHPE World Conference in Vancover in June 2007. This paper contextualizes and discusses Salutogenesis and Antonovsky in the development of health promotion practice and research and, further, relates the salutogenic concept Sense of Coherence (SOC) to the Ottawa Charter. An overview of the development of health pro- motion and the salutogenic theory of health is presented. In addition, this is illustrated in a new way using the metaphors of 'health in the river of life' and 'SOC in a life course perspective'. Health promotion, including the Ottawa charter, lacks a clear theoretical foundation. The results of a systematic review of salutogenic research are used to demonstrate how the salutogenic framework could support the philosophical and practical intentions of the OC. The salutogenic model contributes to the maintenance and development of health and quality of life (QoL), i.e. the process and outcome of the principles of the OC. The metaphor of the river and the life cycle are new ways of demonstrating the paradigm shift provided by the Salutogenesis and health promotion in relation to public health and medicine. The salutogenic theory is an important contribution to the theory base of health promotion research and practice. [ABSTRACT FROM AUTHOR]

Body dissatisfaction, dieting, eating disorders and exercise disorders are prevalent among male and female university students worldwide. Male students are also increasingly adopting health-damaging, body-image-related behaviors such as excessive weight lifting, body building and steroid abuse. Given the severity and difficulty of treating eating disorders, prevention of these problems is a recognized public health goal. Health promotion and health education programs have been conducted in the university setting since the mid 1980s, but few have achieved significant improvements in target health attitudes and behaviors. In this paper, 27 large, randomized and controlled health promotion and health education programs to improve body dissatisfaction, dieting and disordered eating and exercise behaviors of male and female college students are reviewed. In general, health education programs to improve body image and prevent eating disorders in the university setting have been limited by small sample sizes and the exclusion of male students. The majority of studies were conducted among either female undergraduate psychology students or women that were recruited using on-campus advertising. The latter reduces the ability to generalize results to the whole university population, or the general community. In addition, there has been a paucity of longitudinal studies that are methodologically sound, as only 82% (22/2 7) of interventions included in the review used random assignment of groups, and only 52% (n = 14) included follow-up testing. Information-based, cognitive behavioral and psycho- educational approaches have been the least effective at improving body image and eating problems among university students. Successful elements for future initiatives are identified as taking a media literacy- and dissonance-based educational approach, incorporating health education activities that build self-esteem, and using computers and the internet as a delivery medium. A newly designed program for Australian university students is described. [ABSTRACT FROM AUTHOR]

This paper describes the Model for Outcome Classification in Health Promotion and Prevention adopted by Health Promotion Switzerland (SMOC, Swiss Model for Outcome Classification) and the process of its development. The context and method of model development, and the aim and objectives of the model are outlined. Preliminary experience with application of the model in evaluation planning and situation analysis is reported. On the basis of an extensive literature search, the model is situated within the wider international context of similar efforts to meet the challenge of developing tools to assess systematically the activities of health promotion and prevention. [ABSTRACT FROM AUTHOR]

Increasingly, researchers are exploring alternative ways of assessing the impact of 'Health Promoting School' (HPS) initiatives, in recognition of the model's emphasis on achieving change that is both enduring and far-reaching. However, it is still assumed that initiatives will lead to immediate change at the individual level. This paper challenges that view and argues that potential markers of success associated with process need to be identified earlier as a means of supporting schools and teachers. Notwithstanding differences in the way the HPS is conceptualized and implemented, four themes are highlighted that have relevance beyond any one school or country. These were drawn from a process evaluation of a European Network of HPSs Project in Scotland. They highlight the ways in which schools were able to successfully adopt HPS principles and the conditions that need to be in place for the HPS concept to flourish. Such indicators need to be given greater recognition as HPS outcomes if schools are to progress beyond the early stages of project implementation. [ABSTRACT FROM AUTHOR]

This paper starts by briefly reviewing the history, theory and practice of the settings approach to promoting public health—highlighting its ecological perspective, its understanding of settings as dynamic open systems and its primary focus on whole system organization development and change. It goes on to outline perceived benefits and consider why, almost 20 years after the Ottawa Charter advocated the approach, there remains a relatively poorly developed evidence base of effectiveness. Identifying three key challenges—relating to the construction of the evidence base for health promotion, the diversity of conceptual understandings and real-life practice and the complexity of evaluating ecological whole system approaches—it suggests that these have resulted in an ongoing tendency to evaluate only discrete projects in settings, thus failing to capture the 'added value' of whole system working. It concludes by exploring the potential value of theory-based evaluation and identifying key issues that will need to be addressed in moving forward—funding evaluation within and across settings; ensuring links between evidence, policy and practice; and clarifying and articulating the theories that underpin the settings approach generically and inform the approach as applied within particular settings. [ABSTRACT FROM AUTHOR]

The context in which public health programmes operate can play an important role in influencing their implementation and effectiveness. An intervention that has been shown to be effective in one setting may turn out to be ineffective somewhere else, even supposing it can be implemented there. Therefore, systematic reviews of public health interventions should appraise the applicability of the intervention process and the transferability of the intervention effectiveness to other localities. However, applicability and transferability appraisal is seldom reported in systematic reviews of public health and health promotion interventions. This paper aims to introduce an innovative approach to bridging this gap. A list of attributes that may impact on applicability and transferability can be developed, based on knowledge of the proposed intervention. Then the applicability and transferability of the intervention to the local setting can be rated, and given a score, based on knowledge of the local setting. This approach provides a useful tool for evaluating public health interventions and provides a reliable basis for informed decision making in resource-poor settings, where rigorous primary studies are lacking and where very limited resources put a high demand on evidence-based approaches to health promotion. [ABSTRACT FROM AUTHOR]

Systematic reviews of public health interventions are fraught with challenges. Complexity is inherent; this may be due to multi-component interventions, diverse study populations, multiple outcomes measured mixed study designs utilized and the effect of context on intervention design, implementation and effectiveness. For policy makers and practitioners to use systematic reviews to implement effective public health programmes, systematic reviews must include this information, which seeks to answer the questions posed by decision makers, including recipients of programmes. This necessitates expanding the traditional evaluation of evidence to incorporate the assessment of theory, integrity of interventions, context and sustainability of the interventions and outcomes. Unfortunately however, the critical information required for judging both the quality of a public health intervention and whether or not an intervention is worthwhile or replicable is missing from most public health intervention studies. When the raw material is not available in primary studies the systematic review process becomes even more challenging. Systematic reviews, which highlight these critical gaps, may act to encourage better reporting in primary studies. This paper provides recommendations to reviewers on the issues to address within a public health systematic review and, indirectly, provides advice to researchers on the reporting requirements of primary studies for the production of high quality systematic reviews. [ABSTRACT FROM AUTHOR]

The incidence of skin cancer is increasing worldwide. Protecting the skin from the sun by wearing protective clothing, using a sunscreen with appropriate sun protection factor, wearing a hat, and avoiding the sun are recommended as primary preventive activities by cancer agencies. In this paper the recent data relating to skin cancer primary preventive behaviour in Australia and other countries is reviewed. Comparison of the studies in a table format summarizing the methods, objectives, participants, findings and implications may be obtained from the corresponding author. The sun protection knowledge, attitudes and behaviour patterns observed in Australia are similar in other countries, although Australian studies generally report higher knowledge levels about skin cancer and higher levels of sun protection. The findings suggest that sunscreen is the most frequent method of sun protection used across all age groups, despite recommendations that it should be an adjunct to other forms of protection. While young children's sun protective behaviour is largely influenced by their parents' behaviours, they are still under protected, and sun protective measures such as seeking shade, avoiding the sun and protective clothing need to be emphasized. Adolescents have the lowest skin protection rates of all age groups. Within the adult age range, women and people with sensitive skin were most likely to be using skin protection. However, women were also more likely than men to sunbath deliberately and to use sun-tanning booths. The relationship between skin protection knowledge and attitudes, attitudes towards tanning and skin protection behaviour needs further investigation. Further studies need to include detailed assessments of sunscreen use and application patterns, and future health promotion activities need to focus on sun protection by wearing clothing and seeking shade to avoid increases in the sunburn rates observed to date. [ABSTRACT FROM AUTHOR]

Back in 1986, the World Health Organization (WHO) produced the Ottawa Charter for Health Promotion. The intention of the charter was to create a framework that conveyed the notions of capacity building into a structured process for health promotion action in specific settings. This charter subsequently provided the vehicle from which the Health Promoting Hospital (HPH) initiative was launched, culminating in the Budapest Declaration of Health Promoting Hospitals (WHO, 1991). The aim of this paper is to investigate the nature and progress of the European HPH movement. Despite the fact that 'pockets' of concerted and progressive activity and evaluation have emerged from the HPH initiative, the majority of the available literature demonstrates a more limited impact than perhaps the WHO might have anticipated for its efforts over the last 15 years or so. Indications are that many of the member European HPH states have struggled to move beyond the 'project' phases of their planned programmes. This is not to detract from the considerable efforts that have been made to establish HPH networks or the continuing attempts to recruit further members/institutions into the movement. Nevertheless, this account concludes that a more concerted evaluation of European HPH progress is needed to accurately measure its impact and progress. If the situation remains unchanged, perhaps a fundamental review of the strategy is worth considering. [ABSTRACT FROM AUTHOR]

In health promotion, enthusiasm for sustainability has frequently overshadowed critical reflection with regard to whether this aim is warranted, let alone feasible. Consequently, the not insubstantial body of literature on sustainability in health promotion is not particularly helpful to decision makers. In this paper we seek to provide some guidance for the development of sustainability for health promotion interventions, arguing that it is necessary to be able to differentiate between (i) levels of social organization which are the focus of change, (ii) the programmes and agencies which are the means employed to achieve change, and (iii) the outcomes or effects that are achieved. Furthermore, funding allocations need to be congruent with programme characteristics if one is serious about achieving sustainability. [ABSTRACT FROM AUTHOR]

In recent years there has been a renewal of interest in community development and partnership approaches in the delivery of health and social services in Northern Ireland. The general thrust of these approaches is that local communities can be organized to address health and social needs and to work with government agencies, voluntary bodies and local authorities in delivering services and local solutions to problems. Since the Ottawa Charter was launched in 1986, government in Northern Ireland has stressed that community development should no longer simply be added on to key aspects of Health and Social Services, but should instead be at the core of their work. There is increasing consensus that traditional approaches to improving health and well-being, which have focused on the individual, are paternalistic and have failed to tackle inequalities effectively. Partnerships within a community development setting have been heralded as a means to facilitate participation and empowerment. This paper outlines the policy background to community development approaches in health promotion and delivery in Northern Ireland. Drawing on evidence from a case study of a community health project it highlights the benefits and difficulties with this approach. The findings suggest that partnerships can positively influence a community's health status, but in order to be effective they require effective planning and long-term commitment from both the state and the local community. [ABSTRACT FROM AUTHOR]

This paper initially presents a rationale for the cost-effectiveness of using patient-driven computers in primary care services. It specifically defines the concepts of prevention and primary care, prior to outlining the advantages of promoting the implementation of prevention practices in primary care. it argues that greater use of computer technology represents one means of cost-effectively optimizing the integration of prevention into routine primary care, and identifies an apparent disjuncture between the potential of computers and the limited success with which attempts to integrate them into routine primary care services have been met, as evidenced in the published international literature. Among several possible explanations for this disjuncture, such as a possible lack of precision with which computers identify at-risk patients, perceived high costs associated with computers and physicians' concerns about the inflexibility and the more impersonal nature of computer interactions, is the apparent failure of researchers to utilize well designed and empirically tested models in the planning, implementation and evaluation of computerized care. An outline for such an approach, utilizing the Precede-Proceed model of health promotion planning and the Diffusion of Innovations theory, is presented. [ABSTRACT FROM AUTHOR]

Concern at widening health and wealth inequities between communities accompanying processes of globalization in recent years are reflected in contemporary definitions of health promotion, premised on the stratagem of individuals and communities increasing control over factors that determine health, thereby improving their health status. Such community empowerment practice is commonly accepted within the health promotion literature as encompassing intrapersonal, interpersonal and socio-political elements. Less articulated and understood, however, are the processes whereby the identities and cultures of marginalized communities intersect with and reverberate through these levels of action. The potential of identity and culture as important individual and community resources within social action takes on further significance within globalized contexts, which simultaneously expose marginalized communities to dominant cultural power relations while affording members new avenues for cultural expression. In this paper we highlight culture and identity as important aspects of the empowerment process, drawing on the experiences of migrant Tongan and Samoan women throughout a social action process in Aotearoa/New Zealand. In particular, narratives of identity and culture within storytelling as an empowerment practice are explicated, as is the articulation of identity and culture within more structurally orientated power relations throughout subsequent activities related to policy advocacy. [ABSTRACT FROM AUTHOR]

This paper presents a case study of the application of a framework for capacity building [Hawe, P., King, L., Noort, M., Jordens, C. and Lloyd, B. (2000) Indicators to Help with Capacity Building in Health Promotions. NSW Health, Sydney] to describe actions aimed at building organizational support for health promotion within an area health service in New South Wales, Australia. The Core Skills in Health Promotion Project (CSHPP) arose from an investigation which reported that participants of a health promotion training course had increased health promotion skills but that they lacked the support to apply their skills in the workplace. The project was action-research based. It investigated and facilitated the implementation of a range of initiatives to support community health staff to apply a more preventive approach in their practice and it contributed to the establishment of new organizational structures for health promotion. An evaluation was undertaken 4 years after the CSHPP was established, and 2 years after it had submitted its final report. Interviews with senior managers, document analysis of written reports, and focus groups with middle managers and service delivery staff were undertaken. Change was achieved in the three dimensions of health infrastructure, program maintenance and problem solving capacity of the organizations. It was identified that the critically important elements in achieving the aims of the project—partnership, leadership and commitment—were also key elements of the capacity building framework. This case study provides a practical example of the usefulness of the capacity building framework in orienting health services to be supportive of health promotion. [ABSTRACT FROM AUTHOR]

Type 2 diabetes is the most common type of diabetes, with a prevalence of at least 4% in Sweden. Aiming at primary prevention of the disease, the Stockholm Diabetes Prevention Program (SDPP) was developed as a joint program between the Departments of Endocrinology, Social Medicine and Epidemiology at the Karolinska Institute. The program was designed to include three stages, i.e. a combine baseline and aetiological study, a community-based intervention program and a follow-up study after 10 years. In 1995, the intervention program was initiated in Stockholm County with the aim of reducing the incidence of type 2 diabetes. The intervention has focused on the whole adult population in three intervention municipalities, where the local authorities have been involved in planning, initiating and implementing the program. Activities to prevent diabetes, aiming at risk factors such as obesity, low physical activity, dietary habits and tobacco use, have been initiated together with people from different fields and backgrounds, and with different ideas and approaches to health promotion and diabetes prevention. This paper provides a description and reflects upon the development and implementation process of SDPP as well as its interaction with the intervention communities. The stage model that was used for planning SDPP will be used for describing the various phases of the program. Over the period of the program, interest and responsibility has grown at the municipal authorities. The program has been a concern for the municipalities, as the program intermediate goals are also important for other health promotion issues. [ABSTRACT FROM AUTHOR]

Health literacy is a concept that can be widely embraced by schools. Schools throughout the world contribute to the achievement of public health goals in conjunction with their educational commitments. In this paper, the interface between a school's core business of education and public health goals is identified, and examples provided in the area of nutrition demonstrating how these links can operate at school level. The structure and function of the health promoting school is described and the author proposes that there is a very close connection between the health promoting school and the enabling factors necessary in achieving health literacy. Major findings in the literature that provide evidence of good practices in school health education and promotion initiatives are described. Also, those factors that make schools effective and which facilitate learning for students are identified. There is a substantial overlap between the successful components of a health promoting school and effective schools. This enables schools to potentially achieve all three levels of health literacy, including level 3—critical health literacy. However, there are three challenges that must be addressed to enable schools to achieve this level: the traditional structure and function of schools, teachers practices and skill, and time and resources Strategies are proposed to address all three areas and to reduce the impediments to achieving the goals of health literacy and public health using the school as a setting. [ABSTRACT FROM AUTHOR]

Social capital potentially affects older adults' access to healthcare services. However, the effects of social capital on the use of various types of healthcare services using longitudinal data have yet to be explored. This study aimed to examine the effects of structural and cognitive social capital on different types of healthcare utilization by older adults in Indonesia. Data were from the Indonesian Family Life Survey (waves 4 and 5) in 2007 and 2014. The sample consisted of participants aged 60 years and older who completed both waves (n = 1374). Healthcare utilization by older adults assessed health posts (posyandu), health checkups, outpatient care and hospital admissions. Social capital consisted of neighborhood trust and community participation. Generalized estimating equation models were used for the analysis. Older adults with high community participation had a higher likelihood of using preventive care in posyandu (OR = 5.848, 95% CI = 2.585–13.232) and health checkup visits (OR = 1.621, 95% CI = 1.116–2.356). Meanwhile, neighborhood trust was related to a higher probability of hospital admissions (OR = 1.255, 95% CI = 1.046–1.505). Social capital significantly affects older adults' preventive and treatment healthcare utilization. Maximizing the availability of social participation and removing barriers to access to preventive and medical care in an age-friendly environment are suggested. [ABSTRACT FROM AUTHOR]

Adolescents' general health status and health behaviors have been closely monitored in recent years. It is estimated that adolescents comprise one-sixth of the world's population. This study examined whether eHealth literacy was predicted via health promotion activities and preventive health practices among Turkish adolescents. This cross-sectional study was conducted between March and May 2022 with 706 adolescents in Çorum, Turkey. A face-to-face questionnaire form was used, including socio-demographic characteristics, preventive health practices, eHealth literacy scale and Adolescent Health Promotion Scale. The data of the research were analyzed with the SPSS 22.0 program. Percentage, mean, Pearson Correlation analysis, and multiple regression analysis were used in the analyzes. The p  < 0.05 value was considered statistically significant in the evaluations. In the study, 55.8% were female, and the mean age of the whole group was 16.09 ± 2.63 years. The mean score on the eHealth literacy scale was 29.40 ± 6.29. The mean of the total scores obtained from the Adolescent Health Promotion Scale was 137.97 ± 21.87. There was a significant positive correlation between eHealth literacy and the Adolescent Health Promotion Scale (p  < 0.001). Multiple linear regression analysis was performed to predict eHealth literacy using the variables of Adolescent Health Promotion and preventive health practices. eHealth literacy positively and significantly predicts health promotion activities (β  = 0.27, t (695) = 7.54, p  < 0.001). eHealth literacy increased annual weight measurement by more than 0.13 (β  = 0.13), annual blood iron measurement by more than 0.16 (β  = 0.16) and annual dental examination by more than 0.11 (β  = 0.11). Developing eHealth literacy interventions will be necessary for environments with a high concentration of adolescents (schools and courses). Also, primary health care services should be integrated with the school environment. [ABSTRACT FROM AUTHOR]

The paper describes output measures of performance of the Western Australian Health Promotion Foundation (Healthway), using a system known as graduated project evaluation (GPE). Results are reported at the basic and process levels of evaluation on 588 health and sponsorship projects, and at the impact level based on surveys of 5710 spectators and participants at 53 sport, arts and racing events sponsored by Healthway funds. At the basic and process levels the average Healthway project reached 7449 people directly and generated media coverage of health messages on 27.3 occasions. It secured, on average, 0.99 healthy structural reforms in recreational or cultural venues, involved the participation of local community members in project administration in 38% of instances, and provided 1596 person-hours of health education. Non-smoking, safe drinking, nutrition, exercise, sun protection, safe sex and injury prevention health messages were promoted using 24 different types of sponsor benefits. Of the 5710 respondents surveyed post-event, 67% were aware of the promoted health message and 82% of these understood what the message meant. Four per cent of all respondents intended to take action ranging from seeking information to adopting the health behaviour. A comparison of the cost-effectiveness of small and large sponsorship projects is given to illustrate the use of GPE to inform funding decisions. Smaller projects outperformed larger projects on all available indicators. We discuss the peculiar features of the health promotion foundation concept, methods to improve its performance and implications for future research. [ABSTRACT FROM PUBLISHER]

Background: In many nations, government fiscal restraint is reducing the ability of public health authorities to mount mass-reach health information advertising campaigns. Strategies for increasing news coverage of health issues, and thereby contributing to policy advocacy, are well recognized, yet under-explored in health promotion research. Objective: To increase news coverage of smoking and health issues by issuing media releases about research judged as newsworthy and important in contributing to tobacco control policy debates. Method: Research reports selected for their potential newsworthiness were promoted in news releases and their news 'hit rates' in New South Wales (Australia) metropolitan media over 5 weeks were compared with the background coverage of tobacco control issues over the same period. Results: Fifty-eight of 283 (20.5%) news reports on tobacco in the study period were generated by the six media releases. Conclusions: News reportage of tobacco control and other public health issues can be increased significantly by the strategic use of news releases alerting journalists to research reports that embody recognizable news values. This is an inexpensive strategy with great potential to advance public health objectives. [ABSTRACT FROM AUTHOR]

Assesses the status of health promotion in Canada as well as the factors that affect its development. Demographic, social and epidemiological trends; Relevance of international factors and trends; Organizational and administrative structures.

Health promotion research and practice consistently reveals that people of colour in the USA face multiple structural and systemic health and social inequities as a direct consequence of racism and discrimination. Recent scholarship on equity and men's health has highlighted the importance of gender—specifically concepts relating to masculinities and manhood—to better understand the inequities experienced by men of colour. A sharper focus on the intersection between race, gender and life stage has also emphasized the importance of early intervention when addressing inequities experienced by boys and young men of colour (BYMOC). This has led to an expansion of health promotion interventions targeting BYMOC across the USA over the past decade. Many of these health promotion strategies have attempted to reduce inequities through action on the social determinants of health, particularly those that intersect with education and justice systems. Reflecting on these developments, this commentary aims to discuss the challenges and opportunities faced by the health promotion community when attempting to reduce health and social inequities experienced by BYMOC. In doing so, the solutions we identify include: strengthening the evidence base about effective health promotion interventions; reducing system fragmentation; promoting connectivity through networks, alliances and partnerships; reducing tensions between collaboration and competition; changing the narrative associated with BYMOC; acknowledging both inclusiveness and diversity; addressing racism and intergenerational trauma; and committing to a national boys and men's health policy. We encourage health promotion researchers, practitioners and policy-makers to adopt these solutions for the benefit of BYMOC in the USA. [ABSTRACT FROM AUTHOR]

The articled suggests ways on how to address ethical problems in health promotion. Health promotion leaders must recognize the need to articulate a coherent moral framework, in which the health promotion practice is based. Health promotion curriculum and in service programs should include ethics courses. Finally, the health promotion sector should consider whether they need to develop a code of ethics just like the one developed by the Public Health Leadership Society in U.S.

Recently studies have focused on how health promotion interventions sometimes sideline issues of social context, framing health as a matter of individual choice and, by implication, a personal responsibility. Part of this criticism is that health promotion interventions often do not draw on situated understandings of the contextual aspects of health and illness practices. Theoretically, this study departs in practice theory and contemporary public heath discussions on targeted health promotion. Based on semi-structured interviews with 18 people living in a social housing association we explored the significance of participating in a preventive health check and how participation configured into everyday life. All participants in our study had been identified with a 'risk' health profile. Overall, we found that they were well aware of their health risks and challenges, and that they reflected a great deal on how their health status was intrinsically linked with their lifestyle and health practices, such as lack of exercise or smoking. The health checks were, however, not able to support or improve their general health, and did not seem to address the challenges the participants seemed to struggle with in life. By way of conclusion, we suggest that we implement a more practice-oriented form of public health that focus on the 'lives' that people live, and the problems that they face. Moreover, attention should be paid to how and to whom health promotion initiatives are offered, in order to ensure the relevance of targeted interventions. [ABSTRACT FROM AUTHOR]

The article reports on the concerns related top the health promotion discussed at raised with the WHO. The concern was about the linking of health promotion to disease prevention and control agenda in the Department of Health Promotion, Non-communicable Disease Prevention and Surveillance. The Ottawa charter health promotion is featured.

Males experience greater mortality and morbidity than females in most Western countries. The Australian and Irish National Male Health Policies aim to develop a framework to address this gendered health disparity. Men's Sheds have a distinct community development philosophy and are thus identified in both policies as an ideal location to address social isolation and positively impact the health and wellbeing of males who attend. The aim of this international cross-sectional survey was to gather information about Men's Sheds, the people who attend Men's Sheds, the activities at Men's Sheds, and the social and health dimensions of Men's Sheds. Results demonstrate that Men's Sheds are contributing a dual health and social role for a range of male subgroups. In particular, Men's Sheds have an outward social focus, supporting the social and mental health needs of men; health promotion and health literacy are key features of Men's Sheds. Men's Sheds have an important role to play in addressing the gendered health disparity that males face. They serve as an exemplar to health promotion professionals of a community development context where the aims of male health policy can be actualized as one part of a wider suite of global initiatives to reduce the gendered health disparity. [ABSTRACT FROM AUTHOR]

The purpose of this study is to understand people's receptivity to seeking out disease prevention counseling from their primary care provider. Since patients' openness to health messages may vary depending on how they seek out their health information, participants were segmented into one of four unique information-seeking groups. This study explores the differences among these groups, what approaches would be most effective in motivating different health consumers to seek out behavioral counseling in the primary care setting and the opportunities during the medical visit most appropriate for this counseling. To this end, a total of 32 focus groups were conducted with American adults. Participants were segmented by information-seeking orientation (independent actives, doctor-dependent actives, independent passives and doctor-dependent passives), age and gender. Findings showed that participants of the four information-seeking groups possessed distinct differences in their desire for and perceived barriers to requesting counseling from their provider. Overall, participants wanted prevention counseling to include tailored information, encouragement and follow-up. Participants among the various segments identified two key windows of opportunity—during a routine checkup and when discussing their family history—where patients and providers can incorporate more in-depth prevention discussions into the medical visit. Findings from this study suggest that targeting health messages according to health consumers' information-seeking orientations may provide an effective tool for practitioners. Additionally, many health consumers are open to behavioral counseling in the primary care setting and would be satisfied if this counseling were integrated into traditional procedures, such as during a routine checkup or when discussing their family medical history. [ABSTRACT FROM PUBLISHER]

The Health Promotion Research Centre of the National University of Ireland, Galway and the University of Zambia's School of Medicine conducted operational research to understand and address the socio-cultural and gender contexts of maternal survival. Together with an analytical policy and programming review and qualitative research, the project process also involved the convening of 'Interest Group' meetings involving intersectoral stake- holders at Central (Lusaka) and Provincial (Kasama) levels. These meetings aimed to catalyse debate and stimulate advocacy on the project theme by using discussion of qualitative research as entry point. Participants came from government departments, civil society groups, the indigenous health system, academia, technical provider associations, and media, advocacy and human rights organisations. We found that engagement in Interest Groups was successful at Provincial level with lively participation from civil society, media and advocacy stakeholders and strong engagement by the health system. The process was welcomed as an opportunity to Jill gaps in understanding about underlying social determinants of health and jointly explore intervention approaches. Overburdened government staff at central level faced with disease-focused interventions rather than underlying contextual determinants, and a weak culture of health sector engagement with civil society, academics and activists, contributed to less successful functioning in Lusaka. Final Dissemination and Discussion Events incorporated material from Interest Group Meetings to stimulate wider discussion and make recommendations. This project highlights the potential value of intersectoral stakeholder discussions from the inception stage of research to stimulate intersectoral exchange and alliance building, inform advocacy, and catalyse the process of research into action. [ABSTRACT FROM AUTHOR]

This study evaluates the effectiveness of a holistic model for treating people living with AIDS in Africa; the model aims to improve knowledge about AIDS prevention and care, increase trust in the health centre, impact behaviour, and promote a high level of adherence to HAART The study took place in the context of the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) programme in Mozambique, designed by the Community of Sant'Egidio to treat HIV patients in Africa. It provides patients with free anti-retroviral drugs, laboratory tests (including viral load), home care and nutritional support. This is a prospective study involving 531 patients over a 12-month period. The patients, predominantly poor and with a low level of education, demonstrated a good level of knowledge about AIDS (more than 90% know how it is transmitted) and trust in the treatment, with a relatively small percentage turning to traditional healers. Overall the patients had a low level of engaging in risky sexual behaviour and a very good level of adherence to HAART (69.5% of the 531 subjects had a pill count higher than 95%). The positive results of the programme's educational initiatives were confirmed with the patients' good clinical results. [ABSTRACT FROM AUTHOR]

Governments and health service providers around the world are under pressure to improve health outcomes while containing rising healthcare costs. In response to such challenges, many regions have implemented services that have been successful in other countries-but 'importing' initiatives has many challenges. This article summarizes factors found to be critical to the success of adapting a US disease management and health promotion programme for use in Italy and the UK. Using three illustrative case studies, it describes how in each region the programme needed to adapt (i) the form and content of the disease management service, (ii) the involvement and integration with local clinicians and services and (iii) the evaluation of programme outcomes. We argue that it is important to implement evidence-based practice by learning lessons from other countries and service initiatives, but that it is equally important to take into consideration the '3Ps' that are critical for successful service implementation: payers, practitioners and patients. [ABSTRACT FROM AUTHOR]

It is an article of faith in health promotion that health challenges cannot be confronted successfully by actors working in isolation. The synergy produced through collaboration is seen as vital. Yet, collaboration is arduous and many collaborations fade before their goals are met. Research is needed to identify factors and processes that promote as well as inhibit the production of synergistic outcomes. To this end, a case study was undertaken of the Global Programme for Health Promotion Effectiveness (GPHPE). The GPHPE reviews and disseminates evidence for the effectiveness of health promotion. Interviews with 20 GPHPE participants were conducted, transcribed and analyzed, and GPHPE documentation provided additional data. The results were used to develop the Bergen Model of Collaborative Functioning. It is a systems model (input, throughput, output) building on earlier research, that adds three new elements suggested by the findings of this study. First, the partnership's mission ― to disseminate evidence of effectiveness ― was identified as a significant input (alongside the conventional inputs of partner resources and financing) that affected the GPHPE's functioning in fundamental ways. Second, positive and negative cycles of interaction were identified that simultaneously strengthened and weakened the GPHPE's ability to sustain itself and produce the desired outcomes. Third, the construct 'antagony' was introduced as a unique type of output, in addition to synergy and additive results, representing unwanted and disturbing outcomes. The Model is constructed to have wide applicability, and further research now underway tests its utility in the study of local and national collaborations. [ABSTRACT FROM AUTHOR]