Health promotion in Australia: An empirical study into the approaches adopted and evidence used by practitioners in their practice

Abstract

Background: Health promotion is commonly defined as “the process of enabling people to increase control over, and to improve, their health”. This definition was originally found in the Ottawa Charter, which was written in 1986 and has been widely considered to be the founding document for health promotion practice. The existing health promotion literature suggests that practitioners have strong commitments to the values and principles presented in the Ottawa Charter and other iconic documents, but their practice contexts may not support the translation and implementation of those values and principles. We currently lack an empirical understanding of how the values and principles underpinning health promotion are conceptualised by practitioners and translated into practice. Methods: A qualitative study was conducted with health promotion practitioners in New South Wales, Australia. 58 semi-structured interviews and 250 hours of participant and non-participant observation were conducted with 54 practitioners. Interviews were recorded and transcribed, and field notes were written during the observations; these were analysed thematically. Results: Health promotion practitioners were committed to improving people’s health effectively and fairly and, to achieve this, worked iteratively between providing people with opportunities for healthy living and enabling them to use the opportunities available to them, concentrating on disadvantaged communities. Practitioners were also committed to evidence-based practice and used different types of evidence for different practical and strategic purposes. Their ideal evidence met both substantive and procedural criteria for evaluating evidence and was primarily generated by practitioners because they found it to be the most useful and relevant to their practice. However, this evidence was lacking in the current evidence base and was not often valued by the system they worked in. Conclusion: This thesis describes practitioners’ conceptualisation of health promotion and how it is translated into their day-to-day practice. It also clarifies the way evidence is valued and used by practitioners, and offers an empirically-based contribution to the ongoing discussions on what and how evidence should be used to guide health promotion practice.