A missing ethical competency? A review of critical reflection in health promotion
Rebecca Tretheway A D , Jane Taylor A , Lily O’Hara B and Nikki Percival CA School of Health and Sport Sciences, Faculty of Science, Health and Education, University of the Sunshine Coast, Sippy Downs Drive, Sippy Downs, Qld 4556, Australia.
B Emirates College for Advanced Education, PO Box 126662, Abu Dhabi, United Arab Emirates.
C Menzies School of Health Research, PO Box 10639, Brisbane, Qld 4000, Australia.
D Corresponding author. Email: rtrethew@usc.edu.au
Health Promotion Journal of Australia 26(3) 216-221 https://doi.org/10.1071/HE15047
Submitted: 29 May 2015 Accepted: 6 October 2015 Published: 10 December 2015
Abstract
Issue addressed: There is increasing emphasis in the health promotion literature on the ethical imperative for the profession to move towards critical practice. A key challenge for health promotion is that critical practice appears both under-developed and under-practiced. This is evident in the omission of critical reflection from Australian and international competencies for health promotion practitioners.
Methods: A narrative literature review was undertaken to explore the current use of critical reflection in health promotion. Critical reflection models relevant to health promotion were identified and critiqued.
Results: There was a dearth of literature on critical reflection within health promotion, despite recognition of its potential to support critical practice. The discipline of critical social work provided literature on the use, effect and outcome of critical reflection in practice. The interdisciplinary critical reflection model was identified as the model most applicable to health promotion. Underpinned by critical theory, this model emphasises both critical and ethical practice.
Conclusions: Critical reflection is a core competency for health promotion practitioners to address the ethical imperative to move towards critical practice. There is a need to explore the application of a critical reflection model in health promotion to determine how it may support critical and ethical practice.
So what?: If health promotion is to meet its ethical responsibilities, then critical reflection needs to be articulated as a core health promotion competency and a model for its application in health promotion developed.
References
[1] Simpson K, Freeman R (2004) Critical health promotion and education: a new research challenge. Health Educ Res 19, 340–8.| Critical health promotion and education: a new research challenge.Crossref | GoogleScholarGoogle Scholar | 15140853PubMed |
[2] Ferreira MS, Castiel LD (2009) Which empowerment, which health promotion? Conceptual convergences and divergences in preventive health practices. Cad Saude Publica 25, 68–76.
| Which empowerment, which health promotion? Conceptual convergences and divergences in preventive health practices.Crossref | GoogleScholarGoogle Scholar | 19180288PubMed |
[3] Taylor J, O’Hara L, Barnes M (2014) Health promotion: a critical salutogenic science. Int J Soc Work Human Serv Pract 2, 283–90.
| Health promotion: a critical salutogenic science.Crossref | GoogleScholarGoogle Scholar |
[4] Fook J. Social work: a critical approach to practice, 2nd edn. London: Sage; 2012.
[5] Agger B (1991) Critical theory, poststructuralism, postmodernism: their sociological relevance. Annu Rev Sociol 17, 105–31.
| Critical theory, poststructuralism, postmodernism: their sociological relevance.Crossref | GoogleScholarGoogle Scholar |
[6] Kahan B (2012) Using a comprehensive best practices approach to strengthen ethical health-related practice. Health Promot Pract 13, 431–7.
| Using a comprehensive best practices approach to strengthen ethical health-related practice.Crossref | GoogleScholarGoogle Scholar | 22764139PubMed |
[7] Parker E, Gould T, Fleming M (2007) Ethics in health promotion: reflections in practice. Health Promot J Austr 18, 69–72.
[8] Masse R, Williams-Jones B. Ehical dilemmas in health promotion practice. In Rootman I, Dupere S, Pederson A, O’Neill M, editors. Health promotion in Canada, 3rd edn (pp. 241–53). Toronto: Canadian Scholars Press; 2012.
[9] Morley C. Practising critical reflection to develop emancipatory change: Challenging the legal response to sexual assault. Farnham, Surrey, UK: Ashgate Publishing; 2014.
[10] Smith JA (2014) Reflections on the framing of ‘health equity’ in the National Primary Health Care Strategic Framework: a cause for celebration or concern? Health Promot J Austr 25, 42–5.
| Reflections on the framing of ‘health equity’ in the National Primary Health Care Strategic Framework: a cause for celebration or concern?Crossref | GoogleScholarGoogle Scholar | 24739778PubMed |
[11] Gregg J, O’Hara L (2007) Values and principles evident in current health promotion practice. Health Promot J Austr 18, 7–11.
[12] Gregg J, O’Hara L (2007) The Red Lotus Health Promotion Model: a new model for holistic, ecological, salutogenic health promotion practice. Health Promot J Austr 18, 12–9.
[13] Australian Health Promotion Association. Core competencies for health promotion practitioners. 2009. Available from: http://www.healthpromotion.org.au/images/stories/pdf/core%20competencies%20for%20hp%20practitioners.pdf [Verified 9 November 2015].
[14] Dempsey C, Battel-Kirk B, CompHP Project Partners. The CompHP core competencies framework for health promotion (short version). Paris: International Union for Health Promotion and Education (IUHPE); 2011.
[15] Carter SM (2014) Health promotion: an ethical analysis. Health Promot J Austr 25, 19–24.
| Health promotion: an ethical analysis.Crossref | GoogleScholarGoogle Scholar | 24739775PubMed |
[16] Kahan B, Goodstadt M (2001) The interactive domain model of best practices in health promotion: developing and implementing a best practices approach to health promotion. Health Promot Pract 2, 43–67.
| The interactive domain model of best practices in health promotion: developing and implementing a best practices approach to health promotion.Crossref | GoogleScholarGoogle Scholar |
[17] Issitt M (2003) Reflecting on reflective practice for professional education and development in health promotion. Health Educ J 62, 173–88.
| Reflecting on reflective practice for professional education and development in health promotion.Crossref | GoogleScholarGoogle Scholar |
[18] Fook J, Kellehear A (2010) Using critical reflection to support health promotion goals in palliative care. J Palliat Care 26, 295–302.
[19] Hartrick G (1998) Developing health promoting practices: a transformative process. Nurs Outlook 46, 219–25.
| Developing health promoting practices: a transformative process.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M%2Fit1WmtQ%3D%3D&md5=e066f6dc922a370bfcb9e8b832bcc86eCAS | 9805341PubMed |
[20] Fleming P (2007) Reflection: a neglected art in health promotion. Health Educ Res 22, 658–64.
| Reflection: a neglected art in health promotion.Crossref | GoogleScholarGoogle Scholar | 17071850PubMed |
[21] Fleming P (2007) Enhancing the empowerment agenda in health promotion through reflective practice. Reflect Pract 8, 315–30.
| Enhancing the empowerment agenda in health promotion through reflective practice.Crossref | GoogleScholarGoogle Scholar |
[22] Speller V, Parish R, Davison H, Zilnyk A, CompHP Project Partners. The CompHP professional standards for health promotion handbook (short version). Paris: International Union for Health Promotion and Education (IUHPE); 2012.
[23] Australian Association of Social Workers (AASW). Practice standards. Canberra: AASW; 2012.
[24] Allen J, Briskman L, Pease B, editors. Critical social work: theories and practices for a socially just world, 2nd edn. Sydney: Allen and Unwin; 2009.
[25] Mattsson T (2014) Intersectionality as a useful tool: anti-oppressive social work and critical reflection. Affilia J Women Soc Wo 29, 8–17.
| Intersectionality as a useful tool: anti-oppressive social work and critical reflection.Crossref | GoogleScholarGoogle Scholar |
[26] Baum F. The new public health, 2nd edn. Melbourne: Oxford University Press; 2002.
[27] Norman CD (2009) Health promotion as a systems science and practice. J Eval Clin Pract 15, 868–72.
| Health promotion as a systems science and practice.Crossref | GoogleScholarGoogle Scholar | 19811602PubMed |
[28] Fook J, White S, Gardner F. Critical reflection in health and social care. In White S, Fook J, Gardner F, editors. Critical reflection: a review of contemporary literature and understandings (pp. 3–20). Maidenhead, UK: Open University Press; 2006.
[29] Reynolds M (1998) Reflection and critical reflection in management learning. Manage Learn 29, 183–200.
| Reflection and critical reflection in management learning.Crossref | GoogleScholarGoogle Scholar |
[30] Fook J, Gardner F. Practising critical reflection: a resource handbook. Berkshire: McGraw-Hill; 2007.
[31] Brookfield S (2009) The concept of critical reflection: promises and contradictions. Eur J Soc Work 12, 293–304.
| The concept of critical reflection: promises and contradictions.Crossref | GoogleScholarGoogle Scholar |
[32] Green BN, Johnson C, Adams A (2006) Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropr Med 5, 101–17.
| Writing narrative literature reviews for peer-reviewed journals: secrets of the trade.Crossref | GoogleScholarGoogle Scholar | 19674681PubMed |
[33] Morley C (2014) Using critical reflection to research possibilities for change. Br J Soc Work 44, 1419–35.
| Using critical reflection to research possibilities for change.Crossref | GoogleScholarGoogle Scholar |
[34] Morley C (2012) How does critical reflection develop possibilities for emancipatory change? An example from an empirical research project. Br J Soc Work 42, 1513–32.
| How does critical reflection develop possibilities for emancipatory change? An example from an empirical research project.Crossref | GoogleScholarGoogle Scholar |
[35] Thompson N, Pascal J (2012) Developing critically reflective practice. Reflect Pract 13, 311–25.
| Developing critically reflective practice.Crossref | GoogleScholarGoogle Scholar |
[36] Gardner F (2007) Creating a climate for change: critical reflection and organisations. Int J Know Cult Change Manage 6, 73–80.