Over the past couple of years I have increasingly been pondering the difference between theory IN health promotion and theory OF health promotion. David Seedhouse (2004) has rightly pointed out that health promotion has poached many theories from other disciplines, particularly those from psychology and sociology, and applied them with in a health promotion context. That is fine, but it hasn’t helped the cause of developing a theory of health promotion. To be fair, some brave souls have tried. Seedhouse followed his criticism of health promotion’s lack of it’s own theoretical foundation and put forward something to get things started. I have a number of issues with this particular model, although there are also many aspects I like about it, but more of that later. David Buchanan (2000) critiqued the very philosophical underpinning of much of traditional health promotion and put forward a convincing argument (in my humble opinion) of the need to take a different perspective from the individual behavior basis used for so long. Rather, he suggests a much more community-based approach that is much more in keeping with the ideas of empowerment so frequently cited in health promotion rhetoric but not often seen in the expert-driven campaigns associated with behavior change approaches.
Patricia Goodson (2010) has obviously been strongly influenced by Buchanan when she wrote her textbook advocating for a more ‘practical’ approach to theory construction – one that is driven by practitioners who are reflective and intimately linked into their own communities.
To this end, I have been working on a theory of health promotion that underpins my own work: that defines it and explains the relationship between the various components, as a whole. This does not prohibit me from drawing on specific theories from other disciplines within specific projects, as health promotion practitioners have always done, but is helping me to define my practice, even while that practice is primarily research related. So far I have been finding this helpful, but I would like to start a conversation with the broader health promotion community re developing these ideas and to generate discussion on what could constitute a theory of health promotion as it seems to me that aside from Goodson’s recent textbook, things have been rather quiet on this front for some time (there seemed to be a flurry of philosophical thinking around a decade ago, but not much since).
First a little about my background. A brief perusal of my blog will reveal a number of interests, most of which have focused around learning and teaching. I have been a academic for 14 years now, teaching nursing and health promotion students, mostly at an undergraduate level, and over the past 6 years, primarily first years. I have worked in the health industry at both ends of the spectrum: in the gym as well as in acute care hospitals, and spent quite a bit of time in general practice. Over the past couple of years I have focused my teaching and research interests on health promotion, and have become particularly interested in community-based participatory research. While much of my previous research has been historically based, I am now becoming involved in contemporary projects, although, I have found my background in history research is quite amenable to this switch, because it is all about understanding context and the complexity of relationships. It is also this diverse background that has perhaps driven me to try and get my head around health promotion in a way that a practitioner may not necessarily contemplate.
So, now to developing a theory of health promotion. I have been significantly influenced by Seedhouse and Buchanan. My criticism of Seedhouse’s model is that it is missing some fundamental aspects, in particular in regards to the impact of spirituality on health. It would be possible, I suppose to put the various dimensions of wellness as the foundation within this model, but nobody seems to be able to agree on what those actually are, or even the number of dimensions! However, I have taken Seedhouse’s basic foundational idea and filled in the boxes with concepts that reflect the sort of thing I have been mostly delving into. I have also put lots of people on this foundation to reflect the community focus of my work rather individual behavior change. I guess the most radical alteration to the original model is the inclusion of community learning between the foundational elements and the representation of the community as it seems to me that community learning holds the key to understanding the relationship between the foundations of health and the health of communities. However, I would stress that this should not be seen as synonymous as ‘health education’ which has the unfortunate association with didactic teaching and information-giving as opposed to a more transformative understanding of learning and teaching.
I know a model doesn’t make a theory and a theory also needs to have some purpose. So far I have used this model over the past year or so to help remind me what I think should be included in health promotion to help define my own research and practice boundaries. It also reminds me that health promotion is a process that should be enabling people to increase their control over their own health destinies, but I have to admit, my thinking hasn’t moved much beyond that. I would be very interested in hearing the views of others regarding these issues.
References
Buchanan, DR 2000, An ethic for health promotion: rethinking the sources of human well-being, Oxford University Press, Oxford.
Goodson, P 2010, Theory in health promotion research and practice: thinking outside the box, Jones and Bartlett Publishers, Sudbury.
Seedhouse, D 2004, Health promotion: philosophy, prejudice and practice, 2nd edition, Wiley, West Sussex.
