Review of competencies for Australian health promotion

Article (PDF Available)inGlobal Health Promotion 10(4):162-71, 197, 209 · February 2003with34 Reads
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Health Promotion Journal of Australia 2008: 19 (3)
184
Introduction
In recent years, a number of projects internationally have
defined and clarified competencies deemed desirable for
working in health promotion. These developments first took
place in the US, and more recently in Australia, New Zealand,
Canada, Israel and Europe.
The earliest developments took place in the late 1970s in
the US to define the role of entry level health educators.
This work led to the latest US project completed in 2004, to
further define and verify the role of advanced level health
educators.
1,2
In Canada, serious activity in this area was first
documented in 2000 and a draft of competencies for health
promotion practitioners was developed in 2006.
3
Similar work
was undertaken in a few other countries such as New Zealand
4
and Israel.
5
Work on the development of core competencies
for health promotion professionals in European countries
has only recently been undertaken by member states of the
European Union and Council of Europe.
6
In Australia, national projects to identify health promotion
competencies were conducted in the early 1990s by the
Western Australian Centre for Health Promotion Research
at Curtin University (WACHPR), with the National Heart
Foundation of Australia (Western Australian Division) and the
Health Department of Western Australia, under the auspices
Potential uses of health promotion competencies
Trevor Shilton, Peter Howat, Ray James, Cheryl Hutchins and Linda Burke
Abstract
Projects in Australia and internationally over the past two decades have sought to define and clarify
competencies required to work in health promotion. It is now apparent that such competencies are very useful
to health promotion practice. However, to date little attempt has been made to describe those uses.
More than 200 health promotion practitioners throughout Australia were engaged in workshops to explore
and define potential uses of health promotion competencies. The suggestions from these 10 workshops are
summarised in eight categories of uses.
Agreed health promotion competencies have potential to impact on recruitment, training, employment policy
and health promotion practice.
Key words: Health promotion competencies, workforce development, training, uses
Health Promotion Journal of Australia 2008; 19:184-88
So what?
There has been significant recent international interest and progress in developing competencies required to
work in the health promotion field. This article moves the discussion on to consideration of the potential uses
of these competencies and illustrates their relevance.
of the Australian Association of Health Promotion Professionals
(now the Australian Health Promotion Association, AHPA).
These projects were developed in a collaborative way through
consultation with the health promotion workforce.
7
The
Australian Health Promotion Competencies were revised in
2001 under the auspices of AHPA and the National Health
Promotion Workforce Development Task Group, a committee
of the National Public Health Partnership Group.
8
A
recommendation of the 2001 study was that the competencies
should be reviewed and updated at least in a five year cycle.
Subsequently, a further revision was conducted by AHPA,
the Public Health Association of Australia Health Promotion
Special Interest Group (PHAA HPSIG), and the International
Union for Health Promotion and Education (IUHPE) SW
Pacific Regional Committee in 2005.
9
The process used for the above studies was subsequently
applied to a similar project in Israel in 2003 and the Health
Promotion Competencies were also a major focus in the
International Union for Health Promotion and Education
(IUHPE) 2004 Melbourne World Conference Workforce
Development Stream. Feedback from conference participants
indicated strong international support for the development
of a set of core competencies for the health promotion
workforce.
10
Perspectives
Health Promotion Journal of Australia 2008: 19 (3)
185
A project management group representing these key
organisations was formed consisting of Trevor Shilton, Peter
Howat, Ray James, Cheryl Hutchins and Linda Burke.
This group attempted to ensure that the Australian health
promotion competencies reflected the views of those who
work in the field, as well as experts in the area. In addition,
the management group conducted research to identify
perceptions regarding the potential uses of health promotion
competencies. This discussion of potential uses for health
promotion competencies draws on a series of workshops
conducted across Australia throughout 2006.
Method
After analysis of data from a sample of 400 health promotion
practitioners and leaders in November 2005,
9
the authors
conducted workshops throughout 2006 to investigate
participants perceptions of the uses for which the
collaboratively developed competencies could be used. Ten
workshops were held in all States and Territories of Australia.
Each workshop followed a similar program which included:
Discussion of the method, results and implications of
research to revise health promotion competencies in
Australia in 2005.
Comparison of 2005 results to similar research in 2001.
Discussion in small groups to:
discuss, then list potential practical uses for collaboratively
developed health promotion competencies in Australia.
The main comments made by the participants about the
potential uses were recorded by one person in each group.
This information was then manually coded and categorised.
Data were then analysed according to the recommendations
of Miles and Huberman (1994),
11
where recurrent patterns
are noted and clustered to form categories of data in order
to generalise meaning. Initially, coding was carried out as a
process of open coding generating eight separate categories.
These were then used as sub-categories for the process of
axial coding. These coding categories were then audited
by two other researchers in order to ascertain whether the
Table 1: Health promotion workshops conducted throughout Australia in 2006.
Date State Facilitators Number in attendance
26 July 2006 Perth, WA Trevor Shilton, Peter Howat, Ray James 38
16 August 2006 Rural WA (VC) Trevor Shilton, Ray James 26
11 September 2006 Melbourne, Victoria Cheryl Hutchins 15
20 September 2006 Canberra, ACT Cheryl Hutchins 8
19 September 2006 Darwin, NT Trevor Shilton 16
24 September 2006 Sydney, NSW Peter Howat 20
27 September 2006 Brisbane, QLD Peter Howat 40
9 October 2006 Hobart, Tasmania Ray James 25
10 October 2006 Davenport, Rural Tasmania Ray James 13
20 October 2006 Adelaide, SA Ray James 26
Total n = 207
interpretations made by the researcher accorded with those
of the participants. Results were then collated and presented
thematically.
The potential uses of health promotion competencies listed
below are derived from discussions in the workshops as well
as from previously published work of the research group.
8,12
In June 2007, the results from the Australian workshops
were presented at the IUHPE World Conference on Health
Promotion and Health Education in Vancouver, Canada. The
uses of competencies identified in the Australian process were
well received in this global forum.
9
Potential uses of health promotion competencies
The uses of health promotion competencies are summarised
within eight categories.
Clarification of definitions of health promotion
There was general agreement that health promotion
competencies should be congruent with recognised definitions
of health promotion. Lists of competencies should be informed
by appropriate definitions of health promotion and health
promotion practice as described in contemporary literature.
In turn, competencies that are developed in consultation
with the workforce can add clarification to definitions of
health promotion and contribute to the evolution of such
definitions to ensure they reflect contemporary practice.
The competencies can provide a common language and
vocabulary for the profession and help to differentiate health
promotion from other allied health professions.
Informing advocacy for health promotion
Workshop participants indicated that they were regularly called
upon to advocate for health promotion with their manager
or employer within their organisation. The competencies
were seen to be useful to explain the scope and relevance
of health promotion to decision makers when advocating to
secure health promotion budgets, or expand health promotion
services. As managers often do not fully appreciate the scope
of health promotion, the competencies could be a useful tool
Perspectives Potential uses of health promotion competencies
Health Promotion Journal of Australia 2008: 19 (3)
186
in enabling the justification of health promotion programs
and expenditures.
Clarification of job roles
A set of agreed health promotion competencies can provide
everyone involved in health promotion activities with a more
comprehensive understanding of the dimensions of the
field. The 10 broad areas or categories and the 84 individual
competencies that were confirmed by the 2006 revision
process in Australia
9
can be used to assist those professionals
with formal university health promotion qualifications to
match the competencies with the courses and unit of study
they have completed. Similarly, the list can help provide
clarification for newcomers to the field, or those who work
in health promotion on an occasional basis. Competencies
can help delineate roles and be used to write job descriptions
for:
designated health promotion workers;
those for whom health promotion is only part of their
role;
individuals who perform specific or specialised roles within
health promotion; and
managers and other stakeholders.
Figure 1 depicts the health promotion workforce in nine
quadrants, defined on the vertical axis by level of specialisation
(specialist, generalist and the broader intersectoral workforce)
and on the horizontal axis by level of seniority or experience
(Manager, practitioner or graduate). Each of these groups has
different needs and require variable competence to perform
their health promotion roles. A future project might review
the relevant core health promotion competencies required
for each of these groups.
There is clearly a role for both specialists and generalists in
the field of health promotion. Accordingly, there is nothing
incongruent with the goal of assigning health promotion roles
to a wide range of people in health and other sectors, while
at the same time acknowledging a role for specialists.
Personnel and human resource management uses of
competencies for employers
Competencies can assist health promotion employers,
managers and supervisors in personnel management
and human resources to improve the health promotion
performance of staff and increase health promotion
effectiveness in the workplace.
Human resource management uses include: definition of
clear job role, establishing appropriate ‘essentialor desirable’
employment criteria, developing interview questions, designing
matrices for ranking answers to questions and employment
criteria, and guiding the establishment of priorities for the
induction of new staff or entry level training.
Managers and policy makers may also use competencies for:
performance management, guidelines for staff supervision,
mentoring systems, facilitating organisational change in
priorities and strategies, and informing policy outcomes.
Building health promotion capacity in the
health workforce
Building health promotion capacity in the health workforce is
a vital strategy for health gain. Health promotion competencies
provide a framework for building capacity in health promotion
organisations and individuals, other members of the health
workforce, and in sectors such as transport, housing, local
government and the environment. Competencies can be used
to determine benchmarks for health promotion organisations
and to set priorities for training activities such as: continuing
education, workshops and seminars, induction programs,
mentoring, secondments and exchange programs.
Building organisational capacity in the health workforce and
in sectors other than health will contribute to increasing the
number of people effectively promoting health.
8
Developing and revising tertiary education courses
Health promotion competencies can be a useful tool for
academics involved in providing education and training in
health promotion in tertiary education.
3,12,13
Some of the
uses include:
Course development
Competencies are useful for curriculum development of
health promotion academic courses, especially three or four
year bachelor degrees. Competencies can also be useful for
identifying the health promotion components of postgraduate
degrees such Master of Public Health programs that might
only have a single core health promotion unit, or Masters of
Health Promotion which might include several specific health
promotion units. There will be more opportunity to include
the full range of competencies in the undergraduate three
or four-year program compared to the postgraduate courses
Health
Promotion
Specialist
Health
Promotion
Part of Role
Broader
intersectoral
workforce
Manager Practitioner
Entry level
graduate
Figure 1: Mapping the health promotion workforce.
Shilton et al. Article
Health Promotion Journal of Australia 2008: 19 (3)
187
which are typically constrained by a single year of course
work. Consequently, this discussion will focus mainly on the
use of competencies for undergraduate degrees.
Specifically, competencies can assist: the identification of
overall course objectives; the identification of unit (subject)
objectives or learning outcomes; the selection of content for
individual units (subjects); and the development of evaluation
processes of individual units. Examples include:
Identification of overall course objectives. The set of
health promotion competencies identified in the 2005/06
project includes broad, logical groupings (e.g.Needs and
Determinants; Planning and Consultation; Community
Empowerment).
9
These groupings can provide an outline
or direction for an academic course (e.g. A three-year
health promotion bachelor degree) by informing or guiding
the development of overall course objectives.
Identification of unit (subject) objectives or learning
outcomes. The specific competencies (n = 83) within 10
categories
9
can be used to guide the development of the
objectives or learning outcomes of the individual units or
subjects (e.g. the three-year Bachelor degree at Curtin
University has 24 units).
12
Selection of content for individual units (subjects). The unit
objectives guide the content and learning activities that
should be included within a particular unit. The course
developers can ensure that there is alignment of the course
content with these unit objectives.
Development of evaluation processes of individual
units (subjects). A unit evaluation typically consists of
three assignments, projects or exams that students are
required to complete for assessment. Completion of these
assessment tasks should enable students to demonstrate
the extent to which they have developed selected
competencies. Students are more likely to understand
the relevance of their studies and therefore will be more
interested and motivated to learn if they are aware that
the assessment tasks are directly based on or aligned to
the unit objectives. This can benefit the student and the
university and ultimately health promotion employers.
Such assessment also provides the unit teaching staff with
feedback about how well the learning activities have assisted
the student in developing those competencies.
Course evaluation and revision
A set of health promotion competencies can be used to assess
existing health promotion academic courses. This process is
probably more suitable for a three or four-year undergraduate
course than for postgraduate courses. A process can be applied
to identify the extent to which a health promotion course
incorporates the main health promotion competencies via
the overall course objectives, the individual unit (subject)
objectives/learning outcomes, subject content, and unit
assessment tasks.
12
This process can also be utilised as part of
a university’s course quality control and review.
To assist job seekers gain employment in
health promotion
To assist graduates gain employment
Graduates of health promotion courses often have difficulty
constructing job applications and developing a resume. Health
promotion competency lists can assist graduates to articulate
the skills and knowledge that they have attained through
course work, research and practicum placements. In addition,
graduates may use the competencies to identify deficiencies
in their skills. They can respond to this by professional
development courses, volunteer work or additional studies
to strengthen or enhance specific areas.
14
To provide recognition of prior experience
Formal qualifications in health promotion are increasingly
important in the job market. However, it is also acknowledged
that adequate recognition should be given to relevant
past experience, creativity and innovation. Health promotion
is an eclectic and inclusive profession and dynamic in
nature. Health promotion competencies provide an
opportunity and a framework for assessing and recognising
competencies and experience independent of formal
qualifications. Practitioners can use the health promotion
competencies language and structure to describe experience
relevant to particular jobs.
To provide a framework for credentialling in
health promotion
Competencies can provide a framework for commencing a
process of credentialling for health promotion professionals.
One essential pre-requisite for credentialling is the identication
of a distinct discipline, with well-articulated, agreed content
that is distinct from other professions. A system to recognise
practitioner experience such as credentialling may lead
to better consistency between States and organisations
for remuneration of health promotion professionals and
provide the way for more structured career paths within the
profession.
2,15
Nevertheless, there are a number of issues that
are relevant to credentialling of health promotion professionals
in Australia.
13
These need careful consideration before such
a system is introduced.
Conclusions
In recent years there has been significant progress in achieving
consensus about agreed health promotion competencies in
Australia. This work has instigated a dialogue in identifying
Perspectives Potential uses of health promotion competencies
Health Promotion Journal of Australia 2008: 19 (3)
188
the range of potential uses of these competencies.
16
Agreed
health promotion competencies can significantly impact
on recruitment, training, employment policy and health
promotion practice. Dialogue between experts, practitioners,
trainers and employers can help to further articulate and
implement the potential uses of these competencies. This has
potential to advance professional practice in health promotion
in Australia and other countries.
References
1. National Commission for Health Education Credentialing. A Competency-
Based Framework for Graduate-Level Health Educators. Whitehall (PA): NCHEC;
1999.
2. Gilmore GD, Olsen LK, Taub A, Connell D. Overview of the National Health
Educator Competencies Update Project, 1998-2004. Health Educ Behav.
2005;32:725-37.
3. Hyndman B. Towards the Development of Canadian Health Promotion
Competencies: Where We’ve Been, Where We Are, and Where We’re Going.
Toronto (CAN): Ontario Health Promotion E-Bulletin [homepage on the
Internet]; 2007 October 25 [cited 25 April 2008]. Available from: http://www.
ohpe.ca/ebulletin/index.php?option=com_content&task=view&id=9068&It
emid=78
4. McCracken H, Rance H. Developing competencies for health promotion training
in Aotearoa-New Zealand. Promotion and Education. 2000;7:40-43, 65.
5. Melville L, Howat P, Shilton T, Weinstein R. Competencies for health promotion
practitioners in Israel. Promotion and Education. 2006;13(3):178-84.
6. Meresman S, Colomer-Revuelta C, Barry M, Davies JK, Lindstrom B, Loureiro
I, et al. A review of professional competencies in health promotion: European
perspectives. International Journal of Health Promotion and Education.
2006;44:113-20.
Authors
Trevor Shilton, National Heart Foundation of Australia (WA Division) and Western Australian Centre for Health Promotion
Research, Curtin University
Peter Howat, Western Australian Centre for Health Promotion Research and Centre for Behavioural Research in Cancer
Control, Curtin University, Western Australia
Ray James, Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia
Cheryl Hutchins, Department of Health, Australian Capital Territory
Linda Burke, Western Australian Centre for Health Promotion Research and Centre for Behavioural Research in Cancer
Control, Curtin University, Western Australia
Correspondence
Mr Trevor Shilton, Heart Foundation, 334 Rokeby Road, Subiaco, Western Australia 6008. Fax: (08) 9388 3383; e-mail: Trevor.
Shilton@heartfoundation.com.au
7. Van Asselt K, Howat P, Henderson H, Shilton T, James R, et al. 1994. Identification
of Competencies for the Health Promotion Practitioner: Phase 1. Proceedings
of the 6th National Health Promotion Conference; 1994 February 13-15;
Melbourne, Australia.
8. Shilton T, Howat P, James R, Lower T. Development of competencies for
health promotion practitioners in Australia. Promotion and Education.
2003;10(4):162-71.
9. Shilton T, Howat P, James R, Burke L, Hutchins C, Woodman R. Health
promotion competencies for Australia 2001-5: trends and their implications.
Promotion and Education. 2008;15(2):21-6.
10. Hutchins C, Shilton T, Howat P, Sann H, et al.
International core competencies
for health promotion: Is it possible to find consensus upon a set of core
knowledge and skills for health promotion? Proceedings of the 18th IUHPE
World Conference on Health Promotion and Health Education; 2004 April
26-30; Melbourne Australia.
11. Miles B, Huberman A.
Qualitative Data Analysis: Data Management and Analysis
Methods. Thousand Oaks (CA): Sage Publications; 1994.
12. Howat P, Maycock B, Jackson L, Lower T, Cross D, Collins J, et al. Development
of competency based university health promotion courses. Promotion and
Education. 2000;7(1):33-8.
13. Redman J, O’Hara L. Perception of credentialing for health promotion
practitioners in Australia. Health Promot J Austr. 2003;14(1):25-31
14. Hazel F, Maycock B, Howat P. Development of an evidence guide for
mapping health promotion competencies. ACHPER Healthy Lifestyles Journal.
2004;51(2):12-17.
15. Allegrante JP, Airhihenbuwa CO, Auld ME, Birch DA, Roe K, Smith BJ. Toward a
unified system of accreditation for professional preparation in health education:
Final Report of the National Task Force on Accreditation in Health Education.
Health Educ Behav. 2004;31:668-83.
16. Shilton T, Howat P, James R, Hutchins C, Burke L.
Uses of the Australian Health
Promotion Competencies. Proceedings of the 19th IUHPE World Conference
on Health Promotion and Health Education; 2007 June 10-15; Vancouver,
Canada.
Shilton et al. Article
    • "Au niveau méthodologique, la quasi-totalité des travaux consultés [9, 10, 12, 14, 15,[18][19][20][21]fait état en préalable d'une analyse de la littérature combinée avec une approche du type consensus d'experts/ conférence de consensus. Certains travaux recourent en complément à une large concertation avec l'utilisation de questionnaires [18, 20] ou de méthode Delphi [10, 12, 14]. Il ressort ainsi qu'aucun de ces travaux ne mobilise une analyse des pratiques dans leur méthodologie alors que ce type de démarche est actuellement préconisé pour élaborer des référentiels robustes [22][23][24]. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Health education concerns all professionals with an impact on the health of populations, especially social welfare, health care and education professionals. The skills of health educators are central to the development of training in this field, but no common guidelines have been defined concerning the qualifications of these professionals which is why the National Institute of Prevention and Health Education, under the aegis of the National Advisory Committee for the Elaboration of Health Education Training Programmes (CCNEPF) conducted the present study Methods: This study was conducted according to a robust methodology comprising analysis of professional practices by means of interviews with a repeated construction and successive consultation phases with the professionals concerned by these questions (national and regional authorities, national associations, professional bodies, health education bodies). Results: A total of 126 health care, social welfare and education professionals were interviewed. Analysis of the interviews, National Advisory Committee expert opinions and stakeholder consultations helped to formalize a mission statement, 4 functions/situations, 66 activities and 11 key skills common to all health education professionals. Discussion: This study provides a common basis for health education training, especially in terms of common skills and to consider new training modalities. It also opens up various research perspectives.
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    • "For example, health promotion competencies were developed in the early 1990s in Western Australia. More recently, in 2006, an extensive consultation process resulted in the development of competencies for health promotion practice in Australia [24]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background In public health, as well as other health education contexts, there is increasing recognition of the transformation in public health practice and the necessity for educational providers to keep pace. Traditionally, public health education has been at the postgraduate level; however, over the past decade an upsurge in the growth of undergraduate public health degrees has taken place. Discussion This article explores the impact of these changes on the traditional sphere of Master of Public Health programs, the range of competencies required at undergraduate and postgraduate levels, and the relevance of these changes to the public health workforce. It raises questions about the complexity of educational issues facing tertiary institutions and discusses the implications of these issues on undergraduate and postgraduate programs in public health. Conclusion The planning and provisioning of education in public health must differentiate between the requirements of undergraduate and postgraduate students – while also addressing the changing needs of the health workforce. Within Australia, although significant research has been undertaken regarding the competencies required by postgraduate public health students, the approach is still somewhat piecemeal, and does not address undergraduate public health. This paper argues for a consistent approach to competencies that describe and differentiate entry-level and advanced practice.
    Full-text · Article · Apr 2009
  • [Show abstract] [Hide abstract] ABSTRACT: 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.
    Full-text · Article · Jul 2003
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