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"It depends on what you mean": a qualitative study of Swedish health professionals' views on health and health promotion
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0003-3025-2690
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2009 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 9, no 191Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The role of health services must be re-oriented towards health promotion to more effectively contribute to population health. One of the objectives of the Swedish public health policy is that health promotion and disease prevention should be an integral part of the health care system and an important component of all care and treatment. However, the uncertainty about what the concepts of health and health promotion mean poses a challenge for implementation. Depending on how these concepts are interpreted, the attitudes of health professionals toward health promoting practices will differ. Thus, a more in-depth understanding of health professionals' views can be a starting point for a discussion about the values and attitudes that influence the current health care system and about the barriers and possibilities for future development of a health promoting health service.

METHODS: Seven focus group discussions (n = 34) were carried out with health professionals, from different health care settings, to understand how they communicate about health and health promotion. The data were analyzed using qualitative content analysis.

RESULTS: The analysis of health professional's general understanding of the concept of health resulted in the category; a multi-facetted concept, whilst the category; a subjective assessment describes what health means to themselves. A third category; health is about life, the whole life. describes their understanding of health as an outcome of a multiplicity of contextually dependent determinants. The health professional's multiple ways of associating health promotion to disease prevention suggest a concept that is diffuse, elusive and difficult to apply in practice. Despite a shared view of health, the health professionals described their health promotion role very differently depending partly on how the concept of health promotion was interpreted. The analysis resulted in the development of three ideal types, labelled the demarcater, the integrater and the promoter describing different strategies for handling a health promotion role in practice.

CONCLUSION: The study suggests that different interpretations of what constitutes health promotion can lead to unnecessary misunderstandings and pose barriers to further development of a health promoting practice.

Place, publisher, year, edition, pages
2009. Vol. 9, no 191
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-30563DOI: 10.1186/1472-6963-9-191ISI: 000271919800002PubMedID: 19845948OAI: oai:DiVA.org:umu-30563DiVA: diva2:284711
Available from: 2010-01-08 Created: 2010-01-08 Last updated: 2017-12-12Bibliographically approved
In thesis
1. En mer hälsofrämjande hälso- och sjukvård: hinder och möjligheter utifrån professionernas perspektiv
Open this publication in new window or tab >>En mer hälsofrämjande hälso- och sjukvård: hinder och möjligheter utifrån professionernas perspektiv
2010 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Introduktion: Under de senaste decennierna har det förts en diskussion om behovet av att omorientera hälso- och sjukvårdens verksamhet för att på ett effektivare sätt bidra till befolkningens hälsa. Detta togs också upp som ett av målen i 2003 års svenska nationella folkhälsopolitik som sedan uppdaterades 2008. Målet ”en mer hälso- främjande hälso- och sjukvård anger att ett hälsofrämjande och sjukdomsförebyggande perspektiv ska genomsyra hela hälso- och sjukvården och vara en självklar del i all vård och behandling. Vårdpersonalen förväntas spela en nyckelroll i genomförandet. Deras inställning till och kunskap om hälsofrämjande kommer sannolikt att ha en stor inverkan på hur målet kommer att tillämpas i framtiden.

Det övergripande syftet med denna avhandling är, att utifrån professionernas perspektiv, analysera möjligheterna till att omorientera hälso- och sjukvården mot en mer hälsofrämjande inriktning. De specifika frågeställningar som avhandlingen avser att besvara är hur vårdpersonalen uppfattar begreppen hälsa och hälsofrämjande, hur de uppfattar den hälsofrämjande rollen samt hur de uppfattar hinder och möjligheter för att ha en hälsofrämjande roll i det dagliga kliniska arbetet.

Metoder: Avhandlingen baseras på fyra delarbeten utgående från två dataset, ett kvalitativt och ett kvantitativt. Sju fokusgrupper genomfördes med totalt 34 informanter från primärvård och olika sjukhuskliniker. Informanterna representerade sju av vårdens stora yrkesgrupper. Data analyserades med kvalitativ innehållsanalys. Uppfattningar och frågor som genererades av den kvalitativa datainsamlingen låg till grund för utformningen av en enkät, som pilottestades och användes i en undersökning. Av totalt 3.751 anställda som arbetade dagtid med kliniskt arbete i Västerbottens läns landsting inbjöds 1.810 att delta. Dessa representerade arbets- terapeuter, barnmorskor, dietister, kuratorer, läkare, sjukgymnaster, sjuksköterskor och psykologer.

Huvudsakliga resultat och konklusion: Majoriteten av vårdpersonalen hade en holistisk syn på hälsa, samtidigt ansåg 40% att hälso- och sjukvården genomsyras av en biomedicinsk syn på hälsa. Begreppet hälsofrämjande framstod som diffust, svårgripbart och därmed svårt att tillämpa i praktiken. Detta var delvis kopplat till en brist på samsyn beträffande förhållandet mellan hälsofrämjande och sjukdoms- förebyggande.

Avhandlingen visar att det finns ett starkt stöd för omorientering av hälso- och sjukvården mot en mer hälsofrämjande inriktning. Majoriteten av de tillfrågade ansåg att hälso- och sjukvården har stor betydelse när det gäller den långsiktiga hälso- utvecklingen i befolkningen och såg ett behov av att utveckla den hälsofrämjande och sjukdomsförebyggande rollen för att på sikt få en effektivare hälso- och sjukvård. Önskan att fokusera mer på hälsofrämjande och sjukdomsförebyggande rapporterades signifikant oftare av kvinnor än män och av primärvårdspersonal jämfört med sjukhus- personal. Speciellt viktigt att beakta är att män och läkare, dvs grupper som ofta har en hög maktposition, rapporterade mindre positiva attityder till en mer hälsofrämjande hälso- och sjukvård, samtidigt som psykologer, arbetsterapeuter och sjukgymnaster oftast rapporterade det motsatta. En medvetenhet om maktrelationerna spelar därför en strategisk roll i förändringsprocessen. De vanligaste hindren för att ha en hälso- främjande roll i det dagliga kliniska arbetet var en pressad arbetssituation, brist på riktlinjer och otydliga mål. Ledningens stöd är avgörande för tillgången till tid och andra resurser som krävs för vårdpersonal att bedriva hälsofrämjande och sjukdomsförebyggande arbete.

Abstract [en]

Introduction: There has been an on-going, active discussion about the need to re-orient health services to contribute more effectively to population health. This was addressed as one of the 2003 National Swedish public health policy goals, which demand health promotion and disease prevention be an integral part of the health care system and an important component of all care and treatment. Health care professionals are thus expected to play a key role in implementing the goal of “a more health-promoting health service”. Their approach to, and knowledge about, health promotion will consequently greatly influence how the goal will be applied in the future.

The aim of this thesis is to describe and analyze the possibilities for re-orienting health services to more health promotion from the perspective of health professionals. The specific aims are to explore how health professionals interpret the concepts of health and health promotion, how they perceive their role in health-promoting practices, and how they view barriers and possibilities for having a health-promoting role in practice.

Methods: The thesis is based on four studies with two sets of data. Seven focus group discussions were carried out with a total of 34 informants from both hospital and primary health care settings. The informants represented major professional groups. Data were analyzed using qualitative content analysis. Perceptions generated by the qualitative study resulted in formulation of a questionnaire that was pilot-tested and used in a survey. Out of a total of 3751 health professionals who work in daytime clinical practice in the province of Västerbotten, 1810 were invited to participate. They represented counselors, dieticians, midwives, nurses, occupational therapists, physical therapists, psychologists and physicians.

Main findings and conclusions: The vast majority of informants hold holistic ideas about health. At the same time, 40% of the health professionals considered health services to be permeated by a biomedical perspective on health. The concept of health promotion appeared to be diffuse, elusive and difficult to apply in practice. This was partly linked to a lack of agreement about the relationship between health promotion and disease prevention. Thus, policy makers have to understand the need for clarification of concepts and the implications for practice.

The thesis found strong support for a reorientation of health services in order to incorporate health promotion. The majority of the respondents believed that health services play a major role in long-term health development in the population and saw a need for health orientation as a strategy to provide more effective health care. Willingness to focus more on health promotion and disease prevention was reported significantly more often by women than men, and by primary health care personnel compared to hospital personnel. Especially noteworthy is that men and physicians, i.e., groups that often possess high positions of power, reported less positive attitudes to a more health-promoting health service, while psychologists, occupational therapists and physiotherapists most frequently reported the opposite. Therefore, awareness (analysis) of power relations must play a strategic role in the process of change. The most common barriers to health promotion roles in daily practice were reported to be heavy workloads, lack of guidelines, and unclear objectives. Management support is critical for the availability of time and other resources required for health professionals to engage in health promotion.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2010. 82 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1388
Keyword
health service, health personnel, re-orientation, qualitative methods, questionnaire, health, health promotion, attitude, perceptions, hälso- och sjukvård, omorientering, kvalitativ metod, enkätstudie, hälsa, hälsofrämjande, attityder
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
hälso- och sjukvårdsforskning
Identifiers
urn:nbn:se:umu:diva-37617 (URN)978-91-7459-112-5 (ISBN)
Public defence
2010-12-03, Sal E04, byggnad 6E, Farmakologi, Norrlands universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-11-19 Created: 2010-11-10 Last updated: 2015-04-29Bibliographically approved

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Johansson, HeleneWeinehall, LarsEmmelin, Maria

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