Toward resourcefulness: pathways for community positive health

Communities are powerful and necessary agents for defining and pursuing their health, but outside organizations often adopt community health promotion approaches that are patronizing and top-down. Conversely, bottom-up approaches that build on and mobilize community health assets are often critiqued for tasking the most vulnerable and marginalized communities to use their own limited resources without real opportunities for change. Taking into consideration these community health promotion shortcomings, this article asks how communities may be most effectively and appropriately supported in pursuing their health. This article reviews how community health is understood, moving from negative to positive conceptualizations; how it is determined, moving from a risk-factor orientation to social determination; and how it is promoted, moving from top-down to bottom-up approaches. Building on these understandings, we offer the concept of ‘resourcefulness’ as an approach to strengthen positive health for communities, and we discuss how it engages with three interrelated tensions in community health promotion: resources and sustainability, interdependence and autonomy, and community diversity and inclusion. We make practical suggestions for outside organizations to apply resourcefulness as a process-based, place-based, and relational approach to community health promotion, arguing that resourcefulness can forge new pathways to sustainable and self-sustaining community positive health.

Long-Term Effects of Integrated Strategies of Community Health Promotion on Diabetes Mellitus Mortality: a Natural Policy Experiment Based on Aggregated Longitudinal Secondary Data

Integrated strategies of community health promotion (ISCHP) are based on intersectoral collaborations using the Health in All Policies approach to address determinants of health. While effects on health determinants have been shown, evidence on the effectiveness of ISCHP on health outcomes is scarce. The aim of this study is to assess the long-term effects of ISCHP on diabetes mellitus mortality (DMM) in German communities. A nonrandomized evaluation based on secondary county-level official data (1998–2016) was performed. In April 2019, 149 communities in Germany with ISCHP out of 401 were identified. Communities with < 5 measurements of DMM, starting before 1999 or after 2015, were excluded. Analyses included 65 communities with ISCHP (IG) and 124 without ISCHP (CG). ISCHP ran for a mean of 5.6 years. Fixed effects (FE) models were used to estimate effects of ISCHP and duration on DMM taking into account the time-varying average age. The FE estimator for DMM is b = − 2.48 (95% CI − 3.45 to − 1.51) for IG vs. CG and b = − 0.30 (95% CI − 0.46 to − 0.14) for ISCHP duration (0–16 years). In the first year of an ISCHP, a reduction of the annual DMM of 0.3 per 100,000 population (1%), and in the 16th year of 4.8 (14%) was achieved. This study provides preliminary evidence of the effectiveness of ISCHP in Germany. Limitations include inaccuracies to classify IG and CG and possible selection bias. Longitudinal county-level data may be an efficient data source to evaluate complex interventions, thereby contributing to further strengthen evidence-based integrated health promotion.

Health Promotion Practices in Nursing: A Scoping Review

This review aimed to describe the concept of health promotion in nursing as one of the domains of nursing practice. Among three-thousand five hundred four (n=3,504) articles from EBSCO, Medline, and Web of Science regarding the health promotion practices in different fields of nursing, only 29 were selected based on the eligibility criteria. Two themes have emerged with five subthemes were developed. The first theme is the health promotion barriers with a subtheme of financial barriers in attaining health promotion and addressing health literacy while the second theme is the health promotion field practices with a subtheme of hospital health promotion set-up, community health promotion set-up, and school health promotion set-up. This literature emphasized that health promotion is important especially in attaining wellness among client/s as well as providing nursing services. ORCID for all authors: Christian Jay S. Orte, PhD, RN (ORCID No. 0000-0002-7230-9491) Ngozi O.B. Nwosu, PhD (c), MAN (ORCID No. 0000-0002-2823-7355) Jestoni D. Maniago, DNS, RN (ORCID No. 0000-0002-8603-3094) Ruby S. Matibag, EdD, RN (ORCID No. 0000-0002-6360-0391) Alma N. Corpuz, EdD, RMT (ORCID No. 0000-0002-0477-8317) Johdel C. Cabaluna (ORCID No. 0000-0002-8289-5973) Ethical Code: IRB Log Number: Not Applicable IRCT Code: Not applicable Conflicts of interest: The authors declare that there are no conflicts of interest. Authors' contributions: C.J.S.O., N.O.B.N., J.D.M., R.S.M., A.M.C., J.C.C. conceived and planned the study. C.J.S.O., N.O.B.N., J.D.M. carried out the data collection. C.J.S.O., J.D.M., R.S.M., A.M.C., J.C.C. contributed to the interpretation of the results. C.J.S.O., J.D.M. took the lead in writing the manuscript. All authors provided critical feedback and helped shape the research, analysis and manuscript. Acknowledgment: The authors would like to thank their institutions for the support in conducting this research. Financial support and sponsorship: This study was funded by the researchers themselves. Keywords: community health promotion; health education; health literacy; health service settings; nursing

¿Qué Pasa Con Papá? Exploring Paternal Responsibilities and Physical Activity in Mexican-Heritage Families

Mexican-heritage children often achieve less physical activity (PA) than their counterparts and are at greater risk for associated comorbidities. Child PA is greatly influenced by their parents, yet researchers have rarely involved fathers in community health promotion. The purpose of this study is to examine Mexican-heritage fathers’ perceptions of responsibilities and self-reported activities. Promotoras recruited fathers (n = 300) from colonies on the Texas–Mexico border and administered Spanish-language surveys including paternal responsibilities, father PA, and PA co-participation. Two researchers coded responses. Open-ended items were coded and cross-tabulations between responsibilities and activities with children were examined. Fathers reported feeling monetary responsibilities most often. Fathers reported engaging in more activities with their sons than daughters; however, fathers engaged in very few activities specifically with their children. Feeling responsible for family expenses was associated with paternal PA co-participation with family and children. This study adds clarity to the role of Mexican-heritage fathers in child PA. Findings highlight potential areas for intervention including supporting fathers to take an active role in their children’s PA.

Building intersectoral networks: the role of health brokers in a community health promotion program

Background In community health promotion programs (HPP) aiming to improve health and reduce health inequities, health brokers can have a crucial role in building and sustaining intersectoral networks. These networks are pivotal for developing and implementing the HPP. However, the role of health brokers is new and there is little insight into the changes in the networks' size and composition over time and the processes that facilitate brokers' networks. The aim of this study was to map the brokers' network in detail and unravel the barriers and facilitators in network building. Methods To study the brokers' networks in a HPP in a Dutch socioeconomically deprived city district, in October 2017 and November 2019 the Composed Network Analysis (CNA) and the Coordinated Action Checklist (CAC) were used, as part of the action research accompanying the HPP. The CNA provides insight into the size and composition of the network and the CAC explores facilitators and barriers in network building and sustaining. Focus groups with the core network members (n = 6) were held to discuss and interpret results. Results The health brokers' network had expanded from an average of 100 contacts in 2017 to about 140 contacts in 2019. Existing contacts (e.g. social work, welfare work) had been strengthened and new partners, e.g. general practitioners and volunteers joined the network. This resulted in an increased attention for health on the agenda of these organizations and several joint activities as part of the HPP. Facilitators were working on a small scale, informal and formal, and frequent personal contacts. The most important barrier was change of partners. Conclusions The health brokers have been successful in and expanding their networks, putting health on the agenda of network partners and supporting activities. As such, the broker is essential in connecting a diverse range of partners and organizations in an intersectoral network in the city district. Key messages Working on a small scale, and with frequent personal, formal and informal contacts facilitated the health brokers network building and sustaining. A health brokers’ role, being initiator, facilitator and connector is essential for continuation of the community health promotion approach.