Health promotion in local contexts and enabling factors : A study of primary healthcare personnel, local voluntary organizations and political decision makers
Year: 2013
Type: dissertation
Study design: Observational Study
Abstract: Municipalities are important arenas in health promotion as many of the determinants of health relate to, and exert their influence in, local contexts. Accordingly, one key question in public-health work is how to support health promotion on the local level. The present study explores and compares health promotion actions in four medium-sized municipalities, with an emphasis on factors influencing engagement. The point of departure is the health promotion strategies described in the Ottawa Charter (WHO 1986) – the focus being on community action for health, health-promoting health services and healthy public policy – and the multilevel health promotion model (Rütten et al. 2000). The overall aim is to further enhance understanding of health promotion action in local contexts. The specific aims are to explore the role of local voluntary associations in health promotion, to compare the emphasis on health promotion in four municipalities with different forms of primary healthcare service production, and, especially, to identify factors associated with comprehensive health promotion action and with health policy impact (effective health promotion actions). The study – part of an evaluation of the production model of primary healthcare in four municipalities in the southern part of Finland – is based on cross-sectional surveys conducted in the four municipalities in 2000, 2002 and 2004 and including all registered local voluntary associations (LVAs), primary healthcare (PHC) personnel (including services for older people) and local politicians. The data were analysed by means of descriptive statistics as well as logistic and linear regression analysis. The findings suggest that a fair proportion of LVAs are interested in action for community health and could be seen as a resource for health promotion in local contexts. There was agreement that the promotion of residents’ health requires cooperation between municipal agencies and LVAs, although cooperation was not particularly strongly emphasized in municipal budget and action plans according to the politicians. Cooperation with municipal agencies was independently associated with LVA engagement in health promotion. PHC personnel appear to be engaged in health promotion primarily on an individual basis. On all three levels (individual, group and population) it was most prevalent in ambulatory care. This was also true in the case of comprehensive action, as well as when health promotion was conceptualized as addressing risk behaviour. There were some differences between the municipalities in terms of level of engagement; the respondents' focus in health promotion and varying opportunities for cooperation are two potential explanations for these differences. Moreover, variables reflecting all the proposed determinants (organizational values, competence and opportunities) were independently associated with the PHC personnel’s engagement in comprehensive health promotion action. These included working conditions that are conducive to health promotion such as being able to use one’s skills and knowledge, and having possibilities for reflection and learning as well as collegial support; knowledge about residents’ health and living conditions; and opportunities to cooperate with partners outside the organization. Similarly, perceived competence and a value orientation towards health as well as opportunities for community participation were independently associated with LVA engagement in comprehensive health promotion action. In addition to the determinants in the theoretical model, the municipality had an influence. There were no inter-municipality differences in the politicians’ evaluations of health promotion actions and their effectiveness (health policy impact). In terms of impact, an emphasis on promoting health and quality of life among older people and the resources (in the form of capacity of PHC and care for older people) were among the most significant elements of health promotion policy on the local level. Contrary to expectations, opportunities for community participation were not associated with the evaluations. The findings reinforce the value of empowerment, community participation and intersectoral cooperation – in other words the principles of health promotion – in the context of Finnish municipalities, providing further evidence as well as highlighting their significance for engagement in health promotion action. The study also provides novel empirical confirmation concerning the applicability of the multilevel health promotion model to the actions of different actors in municipalities, in other words in local contexts. In support of action on the local level, the findings – the equally strong associations of organizational values, competence and opportunities with engagement in health promotion – suggest the need for a multilevel approach. However, local policy makers may need more evidence concerning the impact of cooperation and community participation.
Source: Työväentutkimus Vuosikirja
Author: Nina Simonsen
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1558731835