Consumer-Driven Embedded Health Promotion and Health Education
Baric, Leo, Blinkhorn, Anthony, International Journal of Health Promotion and Education
The concept of embedded health promotion and health education (HP/HE) is discussed. The key feature is that HP/HE loses its professional identity as it becomes a core activity for all health professionals. Counselling and coaching individuals as part of individual health education by health professionals is an important innovation. However, researchers will have to test new methods of assessing the value-added component of this new HE activity. In addition, the new approach will focus on positive rather than negative messages.
Key words: embedded health promotion and health education, health coaching, consumers, value added, positive message.
The government White Paper Choosing Health--Making Healthy Choices Easier (DoH 2004) represents an important contribution to policies concerning people's health and disease. It will have a profound impact on existing practice in health promotion and health education (HP/HE), which will need to introduce an additional new approach to meet the new demands. This new approach has been developed by the authors and published in a book presenting a new HP/HE model of embedded HP/HE (Bariae & Blinkhorn 2006). The model deals with a consumer-driven embedded approach, where HP/HE does not represent a project or a separate task, additional to core activities within a setting such as hospital, but becomes a part of the core activity of a professional group, based on the specific needs and capabilities of consumers. The model should be considered as an extension of the HP/HE activities to include health and nursing professionals and not a replacement of the present activities carried out by HP/HE professionals. The embedded approach means that HP/HE loses its professional identity and cannot be differentiated from the other aspects of a professional core activity in a setting. To compensate for the lack of HP/HE identity the model presents a new way of assessing the effectiveness of HP/HE by treating it as a value-added aspect of health care. The advantage for the consumers is that they benefit from high-quality HP/HE as a part of the holistic health service provision.
Some form of HP/HE has historically always been a part of the survival strategy of humans. It is only relatively recently that the activities have become formalised and been recognised as independent professional activities. The conceptual differentiation between health education and, later, health promotion stems from the Alma Ata conference (WHO 1978), when it was decided that health education, which deals with personal factors and individuals, was not in itself sufficient. The activity should also include health promotion as a political activity, concerned with health aspects of social and physical environments within which people live, work and play.
The period between the Alma Ata conference and the Ottawa conference (WHO 1986) was characterised by a number of international conferences and declarations, mainly related to the improvement of health promotion. In the post-Ottawa period, however, with the shift of emphasis from medical problems to people with medical problems within various settings, the neglect of the research-based development of health education in Europe was a serious problem.
This became obvious with the introduction of the 'settings' approach (Bariae 1994) and the creation of 'health promoting settings', which were expected to carry out a number of health promotion pilot projects in order to gain national and international recognition. This resulted in a project approach and the introduction of HP/HE in the form of specific projects into settings, executed according to the principles of project management and involving a distinct group of actors. An example is the HP/HE projects in Health Promoting Pilot Hospitals (Pelikan et al 1998a, 1998b). It was widely expected that the successful projects, carried out by voluntary groups of activists in a hospital and supported by evidence-based improvements in clients' health, would be accepted by all the other members of a hospital. …