Defining sustainable practice in community-based health promotion: A Delphi study of practitioner perspectives
Neil Harris A C and Maria Sandor BA Population & Social Health Research Program, Griffith Health Institute, Griffith University, Gold Coast Campus, Qld 4222, Australia.
B Public Health, School of Life Sciences, University of Skövde, 541 28 Skövde, Sweden.
C Corresponding author. Email: n.harris@griffith.edu.au
Health Promotion Journal of Australia 24(1) 53-60 https://doi.org/10.1071/HE12908
Submitted: 28 June 2012 Accepted: 27 October 2012 Published: 27 March 2013
Abstract
Issue addressed: Sustainability of practice must be a central imperative in the practice of community-based health promotion to achieve population health and attract a greater share of public health spending. Although there has been some consideration of sustainability at the project or program levels, often understood as intervention longevity, very limited attention has been given to understanding sustainable practice.
Methods: The present study develops a definition and features of sustainable practice in community-based health promotion through a Delphi method with health promotion practitioners in Queensland, Australia.
Results: The study presents a consensus definition and features of sustainable practice. The definition highlights the importance of collaboration, health determinants and aspirations, processes and outcomes. The four features of sustainable practice identified in the study are: (1) effective relationships and partnerships; (2) evidence-based decision making and practice; (3) emphasis on building community capacity; and (4) supportive context for practice.
Conclusions: The definition and features are, to a large extent, consistent with the limited literature around sustainability at the project and program levels of health promotion. Together, they provide insight into a form of community-based health promotion that will be both viable and productive.
So what?: This consensus understanding of sustainable practice articulates the foundations of working effectively with local communities in achieving improved population health within global limits.
Key words: sustainability, community-based intervention, health promotion theory.
References
[1] Catford J (2004) Health promotion’s record card: how principled are we 20 years on? Health Promot Int 19, 1–4.| Health promotion’s record card: how principled are we 20 years on?Crossref | GoogleScholarGoogle Scholar | 14976166PubMed | [Editorial]
[2] Labonte R (2005) The future of health promotion. Health Promot J Austr 16, 172–6. [Editorial]
[3] McLaren L, Hawe P (2005) Ecological perspectives in health research. J Epidemiol Community Health 59, 6–14.
| Ecological perspectives in health research.Crossref | GoogleScholarGoogle Scholar | 15598720PubMed |
[4] Australian Institute of Health and Welfare (AIHW). National public health expenditure report 2005–06. Canberra: AIHW; 2008.
[5] Johnson K, Hays C, Center H, Daley C (2004) Building capacity and sustainable prevention innovations: a sustainability planning model. Eval Program Plann 27, 135–49.
| Building capacity and sustainable prevention innovations: a sustainability planning model.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXmsVKgtro%3D&md5=2fc4c65160551d935fd61d392ff649eaCAS |
[6] Shediac-Rizkallah MC, Bone LR (1998) Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res 13, 87–108.
| Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3jvVKitA%3D%3D&md5=36fe86ddfdbc8167e78f62f9da9f94a8CAS | 10178339PubMed |
[7] Swerissen H, Crisp BR (2004) The sustainability of health promotion interventions for different levels of social organization. Health Promot Int 19, 123–30.
| The sustainability of health promotion interventions for different levels of social organization.Crossref | GoogleScholarGoogle Scholar | 14976180PubMed |
[8] Pluye P, Potvin L, Denis JL, Pelletier J (2004) Program sustainability: focus on organizational routines. Health Promot Int 19, 489–500.
| Program sustainability: focus on organizational routines.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2crovVaguw%3D%3D&md5=65d794649408f31e860c09616923f410CAS | 15520036PubMed |
[9] St Leger L (2005) Questioning sustainability in health promotion projects and programs. Health Promot Int 20, 317–19.
| Questioning sustainability in health promotion projects and programs.Crossref | GoogleScholarGoogle Scholar | 16272161PubMed |
[10] Pluye P, Potvin L, Denis J-L (2004) Making public health programs last: conceptualizing sustainability. Eval Program Plann 27, 121–33.
| Making public health programs last: conceptualizing sustainability.Crossref | GoogleScholarGoogle Scholar |
[11] Baum F. The new public health, 3rd edn. Sydney: Oxford University Press; 2008.
[12] McMichael AJ. Human frontiers, environments and disease: past patterns uncertain futures. Cambridge: Cambridge University Press; 2001.
[13] Labonté R (1991) Econology: integrating health and sustainable development. Part one: theory and background. Health Promot Int 6, 49–65.
| Econology: integrating health and sustainable development. Part one: theory and background.Crossref | GoogleScholarGoogle Scholar |
[14] Brown VA, Ritchie J (2006) Sustainable communities: what should our priorities be? Health Promot J Austr 17, 211–16.
[15] Brown VA, Grootjans J, Ritchie J, Townsend M, Verrinder G. Sustainability and health: supporting global ecological integrity in public health. Crows Nest, NSW: Allen & Unwin; 2005.
[16] Boutilier M, Cleverly S, Labonte R. Community as a setting for health promotion. In Poland B, Green L, Rootman I, editors. Settings for health promotion: linking theory and practice (pp. 250–307). Newbury Park, CA: Sage; 2000.
[17] Yin RK, Quick SS, Bateman PM, Marks EL. Changing urban bureacracies: how new practices become routinized. Santa Monica, CA: Rand Corporation; 1978.
[18] Mancini JA, Marek LI (2004) Sustaining community-based programs for families: conceptualization and measurement. Fam Relat 53, 339–47.
| Sustaining community-based programs for families: conceptualization and measurement.Crossref | GoogleScholarGoogle Scholar |
[19] Bowles N (1999) The Delphi technique. Nurs Stand 13, 32–6.
[20] Landeta J (2006) Current validity of the Delphi method in social sciences. Technol Forecast Soc Change 73, 467–82.
| Current validity of the Delphi method in social sciences.Crossref | GoogleScholarGoogle Scholar |
[21] Queensland Health. Queensland Health population health plan 2007–2012. Brisbane: Queensland Government; 2008.
[22] Powell C (2003) The Delphi technique: myths and realities. J Adv Nurs 41, 376–82.
| The Delphi technique: myths and realities.Crossref | GoogleScholarGoogle Scholar | 12581103PubMed |
[23] Keeney S, Hasson F, McKenna H (2006) Consulting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs 53, 205–12.
| Consulting the oracle: ten lessons from using the Delphi technique in nursing research.Crossref | GoogleScholarGoogle Scholar | 16422719PubMed |
[24] Crisp J, Pelletier D, Duffield C, Adams A, Nagy S (1997) The Delphi method? Nurs Res 46, 116–18.
| The Delphi method?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s3lvFaitA%3D%3D&md5=d7e22389a76d7abd96862c9750d95675CAS | 9105336PubMed |
[25] Marmot M, Wilkinson RG, editors. Social determinants of health, 2nd edn. New York: Oxford University Press; 2006.
[26] Sparks M (2009) Acting on the social determinants of health: health promotion needs to get more political. Health Promot Int 24, 199–202.
| Acting on the social determinants of health: health promotion needs to get more political.Crossref | GoogleScholarGoogle Scholar | 19661267PubMed | [Editorial]
[27] Butterfoss FD, Francisco VT (2004) Evaluating community partnerships and coalitions with practitioners in mind. Health Promot Pract 5, 108–14.
| Evaluating community partnerships and coalitions with practitioners in mind.Crossref | GoogleScholarGoogle Scholar | 15090164PubMed |
[28] Jackson SF, Perkins F, Khandor E, Cordwell L, Hamann S, Buasai S (2006) Integrated health promotion strategies: a contribution to tackling current and future health challenges. Health Promot Int 21, 75–83.
| Integrated health promotion strategies: a contribution to tackling current and future health challenges.Crossref | GoogleScholarGoogle Scholar | 17307960PubMed |
[29] Corbin JH, Mittelmark MB (2008) Partnership lessons from the Global Programme for Health Promotion Effectiveness: a case study. Health Promot Int 23, 365–71.
| Partnership lessons from the Global Programme for Health Promotion Effectiveness: a case study.Crossref | GoogleScholarGoogle Scholar | 18835888PubMed |
[30] McQueen DV (2001) Strengthening the evidence base for health promotion. Health Promot Int 16, 261–8.
| Strengthening the evidence base for health promotion.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvmsVGlsA%3D%3D&md5=9ecbdce53ced135098017eebc6f2a16aCAS | 11509462PubMed |
[31] Labonte R (1990) Empowerment: notes on professional and community dimensions. Can Rev Social Policy 26, 64–75.
[32] World Health Organization (WHO). Global strategy for health for all by the year 2000. Geneva: WHO; 1981.
[33] Davies S. Empowerment and health: a community development approach to health promotion. In Purdy M, Banks D, editors. Health and exclusion (pp. 137–58). London: Routledge; 1999.
[34] Raeburn J, Akerman M, Chuengsatiansup K, Mejia F, Oladepo O (2006) Community capacity building and health promotion in a globalized world. Health Promot Int 21, 84–90.
| Community capacity building and health promotion in a globalized world.Crossref | GoogleScholarGoogle Scholar | 17307961PubMed |
[35] Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organization; 2008.
[36] Siegrist J, Marmot M (2004) Health inequalities and the psychosocial environment: two scientific challenges. Soc Sci Med 58, 1463–73.
| Health inequalities and the psychosocial environment: two scientific challenges.Crossref | GoogleScholarGoogle Scholar | 14759690PubMed |
[37] Altman DG (1995) Sustaining interventions in community systems: On the relationship between researchers and communities. Health Psychol 14, 526–36.
[38] O’Loughlin J, Renaud L, Richard L, Sanchez Gomez L, Paradis G (1998) Correlates of the sustainability of community-based heart health promotion interventions. Prev Med 27, 702–12.
[39] Alexander JA, Weiner BJ, Metzger ME, Shortell SM, Bazzoli GJ, Hasnain-Wynia R, Sofaer S, Conrad DA (2003) Sustainability of collaborative capacity in community health partnerships. Med Care Res Rev 60, S130–60.
[40] Pluye P, Potvin L, Denisc J-K, Pelletier J, Mannonie C (2005) Program sustainability begins with the first events. Eval Program Plann 28, 123–37.
[41] Smith BJ, Tang KC, Nutbeam D (2006) WHO Health Promotion Glossary: new terms. Health Promot Int 21, 340–5.
[42] Gruen RL, Elliott JH, Nolan ML, Lawton PD, Parkhill A, McLaren CJ, Lavis JN (2008) Sustainability science: an integrated approach for health-programme planning. Lancet 372, 1579–89.