Evaluating A Salutogenic Approach to Health Promotion - Iuhpe ...

Evaluating A Salutogenic Approachto Health Promotion: Guidelines forPractitionerLynne Kennedy (PhD), Glyndwr University, Wales, UKProfessor Paolo Contu, Univ. Cagliari, Sardinia, ItalyLenneke Vaandrager (PhD), Wageningen University, NetherlandsETC European Training Consortia Health Promotion Public Health

Session aimsTo engage in conversations on...• Salutogenic approaches and health promotionpractice• Why is evaluation problematic?• What alternatives are available to practitioners?

Salutogenic concept• Salus (health, invincibility, well being, happiness) genese (origin)

Salutogenesis and Health Promotion(WHO, 1986:1)“… is the process of enabling individuals andcommunities to increase control over, and toimprove their health”• …is a resource for every day living, not theobjective or purpose of life

Salutogenic interpretation of theOttawa Charter”(Erikson & Lindstrom)• societies should empowerpeople to participate indecision making processes…people can create conditionsin which they can makecoherent experiences to buildup a strong SOC• Such societies promote healthand strengthen peoples´competences to manage theemerging problems of daily life

Evaluation and health promotion• Health promotion activity is a complex process• Involves highly subjective indicators• Evaluation is problematic; evidence base is (still)limited• What counts as evidence in health promotion isstrongly contested• Ideology and values and principles strongly influencewhat is accepted as valid evidence (EBP, e.g. NationalInstitute Clinical Excellence NICE)

Pathogenic /Salutogenic research & evaluation1. Epidemiological/demographic analysis1. Goal is health outcome2. Organised arounddisease categories3. Focus on weakness4. Asks ‘how we canmotivate people todo…?’1. Social analysis2. Goal is health outcomeAND increasedcommunitycompetence3. Organised aroundpeople4. Focus on strengths5. Asks ‘what are peoplesmotives?’

CASE STUDY:• In your tutorial groups• clearly state your research aims and objectives• briefly outline your action plan/intervention• using a Salutogenic or asset based model identifya set of evaluation indicators (individual,community, organisation, policy) for your project• identify potential opportunities and issues arising• Feedback: briefly state your objectives ANDselect 2-3 examples of your ‘most’ salutogenicindicators

ConversationTurn to you partner and using an ‘asset’ ratherthan a ‘deficit’ model, identify two possibleindictors for each of the 3 levels:1. Individual2. Community3. Organization

Assets based model –(Morgan & Ziglio, 2006)• Redress balance between evidence for healthpromotion practice derived from deficit(problems) and asset (capability) model• Asset: Any factor or resource which enhances• Asset: Any factor or resource which enhancesthe ability of individuals, communities,populations, social systems or institutions tomaintain and sustain health and wellbeing.

Health assets at individual level:• Social competence• Resistance skills• Commitment to learning• Positive values• Self esteem• Sense of purpose

At the community level:• Family and friendship (supportive) networks• Inter-generational solidarity• Community cohesion• Affinity groups (mutual aid)• Religious tolerance and harmony

At organisational level• Environmental resources necessary for promotingphysical, mental and social health• Employment security• Safe and pleasant housing and neighbourhoods• Political democracy• Participation opportunities• Social justice• Equity enhancing policies

Salutogenic health promotionresearch:• The problem may not be one of lack ofevidence but conceptualisation of health andwhere we look for evidence• We need a framework that helps understandcombined factors required to effect andstrengthen population health and wellbeing• Need to employ participatory approaches

THANK YOU FOR LISTENINGQUESTIONS?

Key Sources• Wannamakers A, (2010)• Lindstrom, B. And Erikson, M (2005)Salutogenesis. J Epidemiology & communityHealth, 59 440-42;5• Federal Centre for Health (1999) What keepspeople healthy? The current state of discussionand the relevance of Antonovosky’s SalutogenicModel of health• Morgan A & Ziglio E (2006) Revitalising theEvidence base for public health: an assets model

Community Asset mapping• A process that fully engages and mobilisescommunities themselves to use their ownassets to visualise a healthy neighbourhoodand community and to identify solutions or aplan to achieve this goal.• Thus, starting with ‘what the community has’and to utilise this in achieving a better qualityof life

Possible evaluation questions:• What are the key assets for health anddevelopment at each of the key stages of lifecourse?• What are the links between these assets andhealth outcomes?• How do these assets work together to bringabout the best health and well beingoutcomes?

• Identifying Asset based protective approaches and health add promoting value tofactors that traditional act together deficit to model support by: health andwell being• Develops policy options required to build andsustain the above• population is regarded as co-producer ofhealth, not only consumer of services• strengthening individual and communitycapacity to reach potential

Asset mapping• Takes positive approach to measuring anddiagnosing community capacity to engage inhealth development activities• Is a process of inventory of the strengths andgifts people who make up a community canbring to health – prior to intervention• Promotes a multidisciplinary approach toevaluation of complex interventions

Asset mapping...• Is a process of building trust betweenprofessionals and local communities• helps conceptualise what is salutogenic orhealth enhancing form the perspectives ofindividuals/ communities and within specificsocial and cultural context• raises self esteem and resourcefulness(empowers) individuals and communities

Health Promotion Strategies (WHO, 2005:3)• Advocate for health based on human rights andsolidarity• Invest in sustainable policies, actions andinfrastructure• Build capacity for policy development, leadership,health promotion practice, knowledge transferand research, and health literacy• Regulate and legislate to ensure a high level ofprotection from harm and enable equalopportunity for health and wellbeing for allpeople