Understanding Facilitators of and Barriers to Health Promotion Practice

Canadian Heart Health Dissemination Project at McMaster University in Hamilton, Ontario, Canada.
Health Promotion Practice (Impact Factor: 0.55). 11/2006; 7(4):467-76. DOI: 10.1177/1524839905278955
Source: PubMed


The health promotion best practices literature is imbued with hope for knowledge mobilization, enhanced practice, and improved population health. Given constrained medical care systems, health promotion is key to reducing the significant burden of chronic disease. However, we have seen little evidence of change. This article investigates facilitators of, and barriers to, three stages of health promotion practice in public health organizations, interagency coalitions, and volunteer committees. The article focuses not on what works but why it does or does not, drawing on five case studies within the Canadian Heart Health Initiative. Results indicate that the presence or absence of appropriately committed and/or skilled people, funds and/or resources, and priority and/or interest are the most common factors affecting all stages of health promotion practice. The article extends the literature on internal and external factors affecting health promotion and highlights strategic influences to consider in support of effective health promotion practice.

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    • "Analysing health promotion projects, Robinson et al. (2006) identified three main barriers to health promotion practice: competing priorities and/or lack of interest, lack of skilled and/or committed people and lack of funds and/or resources. Adapting these to the Youth sports clubs' potential as health promoting setting 10 sports club setting resulted in a list of nine barriers to include health promotion in the club's policy and actions (Table 2). "
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    ABSTRACT: Setting and Objective: For decades, the World Health Organisation has promoted settings-based health promotion, but its application in leisure settings is minimal. Focusing on organised sports as an important leisure activity, the present study had three goals: exploring the health promotion profile of youth sports clubs, identifying objective club characteristics (e.g. size, type of sport), predicting the presence/absence of health promotion in youth sports clubs and identifying perceived motives and barriers to health promotion in youth sports clubs, thereby improving the basis for policy guidelines. Method: Respondents were representatives from the board of 154 youth sports clubs. Data were collected through an online survey, including the health-promoting sports club index (HPSC-I). Linear regression and analysis of variance were used to identify predictors and differences. Results: Even though the motives were strongly supported, a majority of youth sports clubs were rated as low health promoting on the HPSC-I (59%). Overall, linear regression indicated that clubs founded more recently, offering multiple types of sports and offering both recreation and competition scored higher on the health promotion indices. Health promotion not being a priority of the board and lack of expertise were identified as the most important barriers. Conclusion: Progress is needed before youth sports clubs can truly be considered health-promoting settings. Policy suggestions are made to address the barriers, for example, financial incentives to maximise efforts and establishing collaborations between sports clubs and health promotion experts.
    Full-text · Article · Sep 2014 · Health Education Journal
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    • "Preventing sickness and promoting health are approaches to meet current and future healthcare demands (Green and Kreuter, 1990; Smith et al., 2004). Further challenges are to find successful methods to develop health care professionals and organizations that will lead to improved development strategies and sustainable health promoting approaches (e.g., Robinson et al., 2006). Despite on-going discussions, promoting and handling change and development in health service organizations is difficult (e.g., Grol and Grimshaw, 2003). "
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    ABSTRACT: Purpose – The study identifies the variation of change strategies used in a complex large scale change program in health and social services in Sweden, aimed at changing professionals' health promoting practices. The purpose is to investigate the change strategies used over time and describe the potential variation in key change agent views, using a framework inspired by De Caluwé and Vermaak's multi paradigm change typology. Design/methodology/approach – The first six years of the regional multi-sector program are examined. Results are based on content analyses of interviews with key change actors, and archival data describing program activities. Respondents belonged to either the strategic or the operational program management team, representing different sectors of health and social services in a region. Findings – Multiple strategy paradigms showed varying influence over the program's different phases, partly due to program progress, change agent influence and/or varying contextual demands. Respondents' views on strategies and program focus varied depending on their program roles. Respondents expressed insights about the varying conditions for change and on the conflicting expectations within and between program management teams. Originality/value – This study introduces the application of a new framework on a large scale, complex change program. The framework sheds light on a number of basic assumptions and change strategies that can be further compared with content and context factors, barriers, facilitators, outcomes, and in turn with other programs.
    Full-text · Article · Oct 2013 · Journal of Organizational Change Management
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    • "The main barriers for programme implementation, high workload and shortage of time, staff or resources, are among the most well recognized in the implementation literature, and our results are thus consistent with previous research [30,31]. However, our findings suggest that improvements in health promotion practices and collaboration are possible to achieve, despite the presence of these common barriers. "
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    ABSTRACT: Background To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme) on professionals' self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation. Methods A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation) in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points. Results Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1) an increase in the extent to which midwives in antenatal care raised issues related to men's violence against women, 2) an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3) an increased use of motivational interviewing (MI) and separate 'fathers visits' in child health care 4) improvements in the supply of healthy snacks and beverages in open pre-schools and 5) increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff. Conclusion This multisectoral programme for health promotion, based on sector-specific intervention packages developed and tested by end users, and introduced via interactive multisectoral seminars, shows potential for improving health promotion practices and collaboration across sectors. Consideration of the key facilitators and barriers for programme implementation as highlighted in this study can inform future improvement efforts.
    Full-text · Article · Oct 2012 · BMC Public Health
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