Evaluation of the health promotion activities of paediatric nurses : Is the Ottawa Charter for Health Promotion a useful framework?
Janet Roden
University of Western Sydney, Nepean NSW
Lynda Jarvis
University of Western Sydney, Australia
PP: 271 - 284
Abstract
Researchers were involved in an evaluative approach to examine the health promotion activities of paediatric nurses from a paediatric tertiary hospital centre (N = 83) and five paediatric non-tertiary hospital centres (N = 48) from Sydney, Australia. The aims of this study were to understand the nature of heath promotion in paediatric nursing practice by examining nurses' attitudes, investigating paediatric nurses' involvement in the five action area of the Ottawa Charter, and identifying barriers to the implementation of health promotion in practice. The researchers developed a health promotion survey based around the Ottawa Charter for Health Promotion (1986a), and a literature review of nurses' involvement in health promotion. Results showed that tertiary paediatric nurses undertook more varied health promotion activities such as creating supportive environments (CSE), re-orienting health services (RHS) and building healthy public policy (BHPP) than did non-tertiary paediatric nurses who were involved in only one action area of the Charter, that of developing personal skills (DPS). This research revealed that within paediatric nursing practice the action areas of the Ottawa Charter of BHPP and CSE were important; and that there is support for the advocacy role of paediatric nurses. There is also evidence that paediatric nurses may have health promotion knowledge deficits associated with the Ottawa Charter, and that the environment of multidisciplinary allied health professionals in a tertiary paediatric centre may positively influence senior paediatric nurses and their capacity to be involved in varied health promotion activities associated with the Ottawa Charter.
Keywords
Paediatric nurses, acute hospital setting, Ottawa Charter for Health Promotion, health promotion activities, evaluation
Article Text
The Ottawa Charter for Health Promotion was adopted at an international conference in Ottawa, Canada to guide the development of health care policies and the delivery of services (Jirojwong & Liamputtong, 2009). The Charter and the new public health movement originated from the Declaration of Alma Ata for Primary Heath Care (World Health Organisation [WHO], 1978). It was associated with addressing socio-economic disadvantage and had an emphasis on a social model of health so that people had access to education, employment and income (Naidoo & Wills, 2009; St. John & Keleher, 2007). Following the Alma Ata the global strategy 'Health for All by the Year 2000' became the guiding force of health promotion for the next twenty years. The Alma Ata was significant because it shifted the power from the providers of health services to the wider community and the consumers of these services (Catford, 2011).
The development of the term 'health promotion' occurred in the 1980s with publication of the document which initiated the Ottawa Conference and Charter (WHO, 1986b). Since the first international health promotion conference in 1986, there have been six international health promotion conferences focusing on the philosophy of Primary Health Care and built on the action areas of the Ottawa Charter. They have been held in Australia, Sweden, Indonesia, Mexico, Thailand (Keleher, MacDougall & Murphy, 2007) and Nairobi (WHO, 2009). As an example of this the Fifth International Health Promotion Conference in Mexico (2000) reaffirmed the philosophy of Primary Health Care (PHC). At this Conference there was also a focus on health inequalities both between and within countries. Both PHC and health inequalities are still highly relevant today (Catford, 2007; Talbot & Verrinder, 2010).
It is clear that the Ottawa Charter has been a powerful guiding influence in the development of health promotion from 1986 to the present (Nutbeam, 2008; Pettersson, 2011). Other important ramifications of the Charter included a focus on a broad rather than a narrow concept of health, making explicit the link between disease processes and health education and health promotion, and acknowledging people's active participation in influencing their own health outcomes (McQueen & Salazar, 2011). Catford (2011) expands further on this saying that the Ottawa Charter was important in identifying the prerequisites for health such as peace, a stable environment, social justice, and material resources of food and education (WHO, 1986b). The Charter further highlighted the role organisations, communities, and individuals needed to play in achieving better health.
Since the origination of the Charter the world has experienced major change in the form of the internet and globalisation. According to Nutbeam (2008) we must retain the Charter but new health promotion strategies need to be developed. This means we must continue to refresh the concept of health promotion, in order to cope with the changing world. Reflections on the success of the Charter in achieving its aims indicates that, despite a plethora of achievements, other authors raise further challenges such as the effects of globalisation on health, for health promoters attempting to deliver programs at both a national and local level. Labonte (2011) challenges health promoters to focus on global levels of determinants of health. The influence of climate change and global capitalism are threatening people's ability to stay healthy. Although he notes signs of political change in some countries the global pandemic of chronic disease must be confronted by structural health promotion change at a global level (Labonte, 2011). Ziglio, Simpson and Tsouros (2011) argue that in view of continued health inequalities among population groups health promotion needs to occupy a central rather than a marginal position in health care which can be achieved by reorienting health systems with government support. They argue that health promoters need to be vigilant advocators of health for this to occur. This calls for health promoters to be actively involved in politics and policy development if sustainable gains via health promotion are to made (Krech, 2011; Pettersson, 2011; Ziglio et al., 2011). Furthermore, Kokeny (2011) states that health policy makers need to give health a higher priority through reinforcing the Ottawa Charter approaches of advocating, enabling and mediation as these are still relevant in the view of economic and financial factors impacting on the world health today.
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