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Towards the Development of Canadian Health Promotion Competencies: Where we’ve been, where we are, and where we’re going

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I. Introduction

The emergence of health promotion as a distinct speciality within public health has given rise to debate about the imposition of formal parameters to better define the scope of health promotion practice. One key aspect of this debate concerns the development of health promotion competencies, a skills-based set of criteria that those working in the field of health promotion should, at least in part, be expected to meet.

In 2007, Health Promotion Ontario (HPO) drafted a set of health promotion competencies. This work was part of a larger process that has evolved from the pan-Canadian Core Competencies for Public Health project initiated by the Public Health Agency of Canada (PHAC). This article provides an overview of the process undertaken to develop the proposed health promotion competencies.

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II. Why Health Promotion Competencies? Why Now?

When first explored at a symposium organized by The Canadian Association of Teachers of Community Health (CATCH) in 2000 (1), participants concluded that health promotion competencies could be useful if they were broadly defined and treated as guidelines. But they were also concerned about putting limitations and rigid interpretations of professional standards on the still-developing field of health promotion.

Developments since the 2000 CATCH symposium underscore the need to focus on health promotion competencies. Two key factors explain the sustained interest in the development of skills-based competencies for health promotion practitioners.

First, there is growing concern about the potential marginalization of health promotion within the broader public health sector. In Ontario these concerns have surfaced through a 2005 Ontario Public Health Resource System (OHPRS) needs assessment survey (2), discussion papers from HPO (3-4), and consultations undertaken with clients of the Ontario Prevention Clearinghouse, one of the key resource centres within the OHPRS (5). Concerns related to the marginalization of health promotion included the following:

  • lower-than-desired credibility for health promotion and health promoters coupled with inconsistent and sometimes minimal understanding on the part of credentialized health professionals (including management of organizations hiring health promoters) about the skill and knowledge sets required to practice health promotion
  • compensation that is not comparable with other public health professionals (community health nurses, public health nutritionists)
  • hiring competitions that do not provide advantage to those with formal training in health promotion.

Second, the broader public health renewal processes have fostered increased recognition of the need to take a competency-based approach to public health workforce development in Canada (6). This was a key message from a series of stakeholder workshops on public health education held early in 2004 (7) and subsequently re-iterated in a review of international best practices for public health workforce development (7). In the fall of 2004, a Public Health Human Resources Joint Task Group commissioned the development of a set of public health core competencies (9), and a draft pan-Canadian Human Resource Development framework was released in 2005 (10). The latter document points to the importance of core competencies for the entire public health workforce as well as competencies for discipline-specific groups.

In the wake of these developments, there has been significant activity among public health disciplines to define a set of competencies for their respective fields. Health promoters working in the field of public health risk further marginalization if they fail to take ownership on a set of competencies that best reflects their unique contribution.

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III.  The Benefits of Health Promotion Competencies

The key reasons for health promoters to identify discipline-specific competencies are as follows:

  • to inform and structure the content of health promotion training programs
  • to assist in the development of competency-based job descriptions for health promoters
  • to inform the development of health promotion training needs and assessment tools
  • to inform curriculum development of continuing education for health promoters
  • to increase understanding of the range of knowledge and skills required by health promoters to effectively plan, deliver, and evaluate health promotion initiatives.

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IV.  Health Promotion Competencies Do Not Equal Accreditation

HPO is not promoting the proposed competencies as an initial step towards the mandatory accreditation of health promoters. HPO respects and acknowledges the position of the Ontario Prevention Clearinghouse (6) that the process for health promotion to become a formally accredited regulated profession would be rigorous, time-consuming, and potentially divisive. The proposed competencies are meant to inform health promotion practice, not to limit or exclude, and by extension, strengthen the practice and field.

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V.  A Proposed Set of Health Promotion Competencies: Starting the Dialogue

In the spring of 2006, HPO hired a consultant to undertake a review of existing health promotion competency criteria (7). Several examples were considered including

  • health promotion competencies developed by Australia and New Zealand (13-14)
  • an academic set of health promotion competencies developed by the M.H.Sc. program in health promotion at the University of Toronto (15),
  • over 60 current job descriptions for health promoters currently in use at Ontario public health units.

The consultant recommended a five-step process for developing an initial draft of competencies for health promoters in Canada:

1.  Start with a clear description of the tasks and responsibilities of health promoters as a reference point for assessing competencies.

2.  Develop a clear idea of how the competencies may be used to identify whether particular statements will fulfill that need or not.

3.  Review the public health workforce core competencies, starting with those in Canada. Highlight those items of particular importance for further description (e.g., particular strengths of health promoters). Flag any obvious gaps. Review other core competency sets as needed.

4.  Review the Australian, New Zealand, and University of Toronto Master of Health Science health promoter competency sets to see if they provide the additional detail and address gaps. See if they provide the appropriate depth and breadth desired to capture health promoter competencies.

5.  Review additional competency sets outlined as required.

This process was applied to guide the development of the following set of health promotion competencies. Specifically, all health promoters should be able to:

1.  Demonstrate knowledge necessary for conducting health promotion that includes:

1.1  Applying a determinants of health framework to the analysis of health issues.
1.2  Applying theory to health promotion planning and implementation
1.3  Applying health promotion principles in the context of the roles and   responsibilities of public health organizations
1.4  Describing the range of interventions available to address public health issues

2.  Conduct a community needs/situational assessment for a specific issue that   includes:

2.1  Identifying behavioural, social, environmental and organizational factors that promote or compromise health
2.2  Identifying relevant and appropriate data and information sources
2.3  Identifying community assets and resources
2.4  Partner with communities to validate collected quantitative and qualitative data
2.5  Integrating information from available sources to identify priorities for action

3.  Plan appropriate health promotion programs that includes:

3.1  Identifying, retrieving and critically appraising the relevant literature
3.2  Conducting an environmental scan of best practices
3.3  Developing a component plan to implement programs including goals, objectives and implementation steps
3.4  Developing a program budget
3.5  Monitoring and evaluating implementation of interventions

4.  Contribute to policy development that includes:

4.1  Describing the health, economic, administrative, legal, social and political implications of policy options
4.2  Providing strategic policy advice on health promotion issues
4.3  Writing clear and concise policy statements for complex issues.

5.  Facilitate community mobilization and build community capacity around shared   health priorities that includes

5.1  Engaging in a dialogue with communities based on trust and mutual respect
5.2  Identifying and strengthening local community capacities to take action on health issues
5.3  Advocating for and with individuals and communities that will improve their health and well-being

6.  Engage in partnership and collaboration that includes:

6.1  Establishing and maintaining linkages with community leaders and other key health promotion stakeholders (e.g., schools, businesses, churches, community associations, labour unions, etc.)
6.2  Utilizing leadership, team building, negotiation and conflict resolution skills to build community partnerships
6.3  Building coalitions and stimulating intersectoral collaboration on health issues

7.  Communicate effectively with community members and other professionals that   includes:

7.1  Providing health status, demographic, statistical, programmatic, and scientific information tailored to professional and lay audiences
7.2  Applying social marketing and other communication principles to the development, implementation and evaluation of health communication   campaigns
7.3  Using the media, advanced technologies, and community networks to receive and communicate information
7.4  Interacting with, and adapting policies and programming that respond to the diversity in population characteristics

8.  Organize, implement and manage health promotion interventions that includes:

8.1  Training and coordinating program volunteers
8.2  Describing scope of work in the context of organization's mission and functions
8.3  Contributing to team and organizational learning

The competencies were written primarily for health promoters working in public health settings in Canada and/or those with the term ‘health promotion' in their job title. These include organizations such as public health departments, community health centres, and regional health authorities. However, the competencies are not meant to exclude individuals practising health promotion in other settings; rather, they are offered as a resource that can help to inform the work of any individual, group or organization engaged in health promotion practice.

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VI.  Building Consensus on Health Promotion Competencies: Continuing the Dialogue

The draft health promotion competencies were initially presented at  HPO's conference in May 2007. They were subsequently presented to an international audience at the 19th Annual International Union for Health Promotion and Education (IUHPE) Conference in Vancouver in June 2007. Participants at both events provided feedback that will be used to further refine the competencies. Additional feedback was captured through an on-line survey that was in place from June to August 2007.

Over the coming year, HPO hopes to undertake further activities to foster consensus on the shared knowledge and skills that constitute effective health promotion practice. HPO welcomes feedback from any individual or organization that shares its commitment to defining and raising awareness of the core competencies required to promote health effectively.

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VII. References

1.  Final report from the Symposium for Teachers of Health Promotion and Community Health (CATCH), October 22, 2000. Available on-line at: http://www.utoronto.ca/chp/CCHPR/teacherssymposiumreport.doc

2.  Rush, B. Report on the 2004-2005 Ontario Health Promotion Resource System Provincial Needs Assessment Toronto: Ontario Health Promotion Resource System, 2005.

3.  Hyndman, B. Health Promoters in Canada: An Overview of Roles, Networks and Trends Toronto: Health Promotion Ontario, 2006.

4.  Feltracco, A., and Wilkerson, T. Health Promotion Ontario: Fulfilling the Promise Toronto: Health Promotion Ontario (public health), 2005.

5.  Ontario Prevention Clearinghouse. Ontario Health Promoters: Gains of Organizing/Risks of Professionalizing: Commentary from the Ontario Prevention Clearinghouse Toronto, 2006.

6.  Moloughney, B. Development of a Discipline-Specific Competency Set for Health Promoters - Findings from a Review of the Literature. Paper prepared for Health Promotion Ontario, April 2006.

7.  Moloughney, B. Pan-Canadian Public Health Education Initiative: Summary of Three Regional Workshops. Ottawa: Health Canada, Centre for Surveillance, Coordination and Health Care Policy Directorate, 2004.

8.  Nevis Consulting Group. Public Health Workforce Development: Australia, England and the United States Ottawa: Nevis Consulting Group, 2004.

9.  Moloughney, B. The development of a draft set of public health workforce core competencies. FPT Public Health Human Resources Joint Task Group, 2004.

10.  Joint Task Group on Public Health Human Resources. Building the public health workforce for the 21st century: a pan-Canadian framework for public health human resources planning Ottawa, 2005.

11.  Shilton, T., Howat, P., and James, R. "Review of competencies for Australian health promotion." Australian Health Promotion Update Oct-Nov, p. 5, 2003.

12.  McCracken, H., and Rance, H. "Developing competencies for health promotion training in Aotearoa-New Zealand." Promotion et Education 7 (1), 40-43, 65, 2000.

13.  Core Competencies of a Health Promoter. M.H.Sc Health Promotion Program, Department of Public Health Sciences, University of Toronto. Available on-line at: http://www.phs.utoronto.ca/mhsc_health_promotion4.asp