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Year : 2012  |  Volume : 37  |  Issue : 1  |  Page : 5-12

Health promotion: An effective tool for global health

International Institute of Health Management Research, New Delhi, India

Date of Submission14-Jan-2012
Date of Acceptance14-Jan-2012
Date of Web Publication19-Mar-2012

Correspondence Address:
Sanjiv Kumar
Dean Training, Research and Publications, IIHMR, Plot No. 3, Sector 18A, Dwarka, New Delhi- 110 075
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-0218.94009

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Health promotion is very relevant today. There is a global acceptance that health and social wellbeing are determined by many factors outside the health system which include socioeconomic conditions, patterns of consumption associated with food and communication, demographic patterns, learning environments, family patterns, the cultural and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change. In such a situation, health issues can be effectively addressed by adopting a holistic approach by empowering individuals and communities to take action for their health, fostering leadership for public health, promoting intersectoral action to build healthy public policies in all sectors and creating sustainable health systems. Although, not a new concept, health promotion received an impetus following Alma Ata declaration. Recently it has evolved through a series of international conferences, with the first conference in Canada producing the famous Ottawa charter. Efforts at promoting health encompassing actions at individual and community levels, health system strengthening and multi sectoral partnership can be directed at specific health conditions. It should also include settings-based approach to promote health in specific settings such as schools, hospitals, workplaces, residential areas etc. Health promotion needs to be built into all the policies and if utilized efficiently will lead to positive health outcomes.

Keywords: Health promotion, mainstreaming health promotion, healthy public policy, issue based approach, healthy settings

How to cite this article:
Kumar S, Preetha G S. Health promotion: An effective tool for global health. Indian J Community Med 2012;37:5-12

How to cite this URL:
Kumar S, Preetha G S. Health promotion: An effective tool for global health. Indian J Community Med [serial online] 2012 [cited 2021 Dec 3];37:5-12. Available from: https://www.ijcm.org.in/text.asp?2012/37/1/5/94009

   Introduction Top

Health promotion is more relevant today than ever in addressing public health problems. The health scenario is positioned at unique crossroads as the world is facing a 'triple burden of diseases' constituted by the unfinished agenda of communicable diseases, newly emerging and re-emerging diseases as well as the unprecedented rise of noncommunicable chronic diseases. The factors which aid progress and development in today's world such as globalization of trade, urbanization, ease of global travel, advanced technologies, etc., act as a double-edged sword as they lead to positive health outcomes on one hand and increase the vulnerability to poor health on the other hand as these contribute to sedentary lifestyles and unhealthy dietary patterns. There is a high prevalence of tobacco use along with increase in unhealthy dietary practices and decrease in physical activity contributing to increase in biological risk factors which in turn leads to increase in noncommunicable diseases (NCD). [1],[2],[3] [Figure 1] below illustrates how lifestyle-related issues are contributing to increase in NCDs. [4] The adverse effects of global climate change, sedentary lifestyle, increasing frequency of occurrence of natural disasters, financial crisis, security threats, etc., add to the challenges that public health faces today.
Figure 1: Illustration of how lifestyle-related issues contribute to increase in noncommunicable diseases[4]

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Health, as the World Health Organization (WHO) defines, is the state of complete physical, social and mental well being and not just the absence of disease or infirmity. The enjoyment of highest attainable standard of health is considered as one of the fundamental rights of every human being. [5] Over the past few decades, there is an increasing recognition that biomedical interventions alone cannot guarantee better health. Health is heavily influenced by factors outside the domain of the health sector, especially social, economic and political forces. These forces largely shape the circumstances in which people grow, live, work and age as well as the systems put in place to deal with health needs ultimately leading to inequities in health between and within countries. [6] Thus, the attainment of the highest possible standard of health depends on a comprehensive, holistic approach which goes beyond the traditional curative care, involving communities, health providers and other stakeholders. This holistic approach should empower individuals and communities to take actions for their own health, foster leadership for public health, promote intersectoral action to build healthy public policies and create sustainable health systems in the society. These elements capture the essence of "health promotion", which is about enabling people to take control over their health and its determinants, and thereby improve their health. It includes interventions at the personal, organizational, social and political levels to facilitate adaptations (lifestyle, environmental, etc.) conducive to improving or protecting health. [1],[2]

   Health Promotion: Historical Evolution Top

Health promotion is not a new concept. The fact that health is determined by factors not only within the health sector but also by factors outside was recognized long back. During the 19 th century, when the germ theory of disease had not yet been established, the specific cause of most diseases was considered to be 'miasma' but there was an acceptance that as poverty, destitution, poor living conditions, lack of education, etc., contributed to disease and death. William Alison's reports (1827-28) on epidemic typhus and relapsing fever, Louis Rene Villerme's report (1840) on Survey of the physical and moral conditions of the workers employed in the cotton, wool and silk factories John Snow's classic studies of cholera (1854), etc., stand testimony to this increasing realization on the web of disease causation.

The term 'Health Promotion' was coined in 1945 by Henry E. Sigerist, the great medical historian, who defined the four major tasks of medicine as promotion of health, prevention of illness, restoration of the sick and rehabilitation. His statement that health was promoted by providing a decent standard of living, good labor conditions, education, physical culture, means of rest and recreation and required the co-ordinated efforts of statesmen, labor, industry, educators and physicians. It found reflections 40 years later in the Ottawa Charter for health promotion. Sigerist's observation that "the promotion of health obviously tends to prevent illness, yet effective prevention calls for special protective measures" highlighted the consideration given to the general causes in disease causation along with specific causes as also the role of health promotion in addressing these general causes. Around the same time, the twin causality of diseases was also acknowledged by J.A.Ryle, the first Professor of Social Medicine in Great Britain, who also drew attention to its applicability to non communicable diseases. [7]

Health education and health promotion are two terms which are sometimes used interchangeably. Health education is about providing health information and knowledge to individuals and communities and providing skills to enable individuals to adopt healthy behaviors voluntarily. It is a combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes, whereas health promotion takes a more comprehensive approach to promoting health by involving various players and focusing on multisectoral approaches. Health promotion has a much broader perspective and it is tuned to respond to developments which have a direct or indirect bearing on health such as inequities, changes in the patterns of consumption, environments, cultural beliefs, etc. [3]

The 'New Perspective on the Health of Canadians' Report known as the Lalonde report, published by the Government of Canada in 1974, challenged the conventional 'biomedical concept' of health, paving way for an international debate on the role of nonmedical determinants of health, including individual risk behavior. The report argued that cancers, cardiovascular diseases, respiratory illnesses and road traffic accidents were not preventable by the medical model and sought to replace the biomedical concept with 'Health Field concept' which consisted of four "health fields"-lifestyle, environment, health care organization, human biology as the determinants of health and disease. The Health Field concept spelt out five strategies for health promotion, regulatory mechanisms, research, efficient health care and goal setting and 23 possible courses of action. Lalonde report was criticized by skeptics as a ploy to stem in the governments rising health care costs by adopting health promotion policies and shifting responsibility of health to local governments and individuals. However, the report was lapped up internationally by countries such as USA, UK, Sweden, etc., who published similar reports. The landmark concept also set the tone for public health discourse and practice in the decades to come. [7],[8],[9],[10] Health promotion received a major impetus in 1978, when the Alma Ata declaration acknowledged that the promotion and protection of the health of the people was essential to sustained economic and social development and contributed to a better quality of life and to world peace. [5]

   Conferences on Health Promotion Top

Growing expectations in public health around the world prompted WHO to partner with Canada to host an international conference on Health Promotion in 1986. It was held in Ottawa, and produced not only the "Ottawa Charter for Health Promotion" but also served as a prelude to subsequent international conferences on health promotion. The Ottawa Charter defined Health Promotion as the process of enabling people to increase control over and to improve their health. To reach a state of complete physical, mental and social well being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. The fundamental conditions and resources for health are: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. Health promotion thus is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well being. The Charter called for advocacy for health actions for bringing about favorable political, economic, social, cultural, environmental, behavioral and biological factors for health, enabling people to take control of the factors influencing their health and mediation for multi sectoral action. The Charter defined Health Promotion action as one a) which builds up healthy public policy that combines diverse but complementary approaches including legislation, fiscal measures, taxation and organizational change to build policies which foster equity, b) create supportive environments, c) support community action through empowerment of communities - their ownership and control of their own endeavors and destinies, d) develop personal skills by providing information, education for health, and enhancing life skills and e) reorienting health services towards health promotion from just providing clinical and curative services. [11]

This benchmark conference led to a series of conferences on health promotion - Adelaide (1988), Sundsvall (1991), Jakarta (1997), Mexico-City (2000), Bangkok (2005) and Nairobi (2009). In Adelaide, the member states acknowledged that government sectors such as agriculture, trade, education, industry and communication had to consider health as an essential factor when formulating healthy public policy. The Sundsvall statement highlighted that poverty and deprivation affecting millions of people who were living in extremely degraded environment affected health. In Jakarta too poverty, low status of women, civil and domestic violence were listed as the major threats to health. The Mexico statement called upon the international community to address the social determinants of health to facilitate achievement of health-related millennium development goals. The Bangkok charter identified four commitments to make health promotion (a) central to the global development agenda; (b) a core responsibility for all governments (c) a key focus of communities and civil society; and (d) a requirement for good corporate practice. [12],[13] The last conference in October 2009 in Nairobi called for urgent need to strengthen leadership and workforce, mainstream health promotion, empower communities and individuals, enhance participatory processes and build and apply knowledge for health promotion.

The health promotion emblem [Figure 2] adopted at the first international conference on health promotion in Ottawa and evolved at subsequent conferences symbolizes the approach to health promotion. The logo has a circle with three wings. It incorporates five key action areas in health promotion (build healthy public policy, create supportive environments for health, strengthen community action for health, develop personal skills and reorient health services) and three basic HP strategies (to enable, mediate and advocate).
Figure 2: Health promotion emblem

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  1. The outer circle represents the goal of "Building Healthy Public Policies" and the need for policies to "hold things together". This circle has three wings inside it which symbolise the need to address all five key action areas of health promotion identified in the Ottawa Charter in an integrated and complementary manner.
  2. The small circle stands for the three basic strategies for health promotion, "enabling, mediating, and advocacy".
  3. The three wings represent and contain the words of the five key action areas for health promotion - reorient health services, create supportive environment, develop personal skills and strengthen community action. [14]
True to its recognition of health being more influenced by factors outside the health sector, health promotion calls for concerted action by multiple sectors in advocacy, financial investment, capacity building, legislations, research and building partnerships. The multisectoral stakeholder approach includes participation from different ministries, public and private sector institutions, civil society, and communities all under the aegis of the Ministry of Health. [3]

   Approaches to Health Promotion Top

Health promotion efforts can be directed toward priority health conditions involving a large population and promoting multiple interventions. This issue-based approach will work best if complemented by settings-based designs. The settings-based designs can be implemented in schools, workplaces, markets, residential areas, etc to address priority health problems by taking into account the complex health determinants such as behaviors, cultural beliefs, practices, etc that operate in the places people live and work. Settings-based design also facilitates integration of health promotion actions into the social activities with consideration for existing local situations. [3]

The conceptual framework in [Figure 3] below summarizes the approaches to health promotion. It looks at the need of the whole population. The population for any disease can be divided into four groups a) healthy population, b) population with risk factors, c) population with symptoms and d) population with disease or disorder. Each of these four population groups needs to be targeted with specific interventions to comprehensively address the need of the whole population. In brief, it encompassed primordial prevention for healthy population to curative and rehabilitative care of the population with disease. Primordial prevention aspires to establish and maintain conditions to minimize hazards to health. It consists of actions and measures that inhibit the emergence and establishment of environmental, economic, social and behavioral conditions, cultural patterns of living known to increase the risk of disease. [15]
Figure 3: Conceptual framework for health promotion

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   Examples of Health Promotion in Communicable and Non-communicable Diseases Top

Health promotion measures are often targeted at a number of priority disease - both communicable and noncommunicable. The Millennium Development Goals (MDGs) had identified certain key health issues, the improvement of which was recognized as critical to development. These issues include maternal and child health, malaria, tuberculosis and HIV and other determinants of health. Although not acknowledged at the Millennium summit and not reflected in the MDGs, the last two decades saw the emergence of NCD as the major contributor to global disease burden and mortality. NCDs are largely preventable by effective and feasible public health interventions that tackle major modifiable risk factors - tobacco use, improper diet, physical inactivity, and harmful use of alcohol. Eighty percent of heart diseases and stroke, 80% of diabetes and 40% of cancers can be prevented by eliminating common risk factors, namely poor diet, physical inactivity and smoking. [16] Against this background health promotion as the "the science and art of helping people change their lifestyle to move toward a state of optimal health" is a key intervention in the control of NCDs. The following paragraphs showcase the application of an issue based approach of health promotion, using communicable and NCDs as examples capturing the components of individual and community empowerment, health system strengthening and partnership development.

   Communicable Diseases Top

These diseases can be adequately addressed through health promotion approach. Here is one example:

Improving use of ITNs to prevent malaria: Insecticide-treated bed-nets (ITNs) are recommended in malaria endemic areas as a key intervention at the individual level in preventing malaria by preventing contact between mosquitoes and humans. (a) The individual level health promotion action would include providing access to ITNs and encouraging their regular and proper use every night from dusk to dawn. Available evidence points to the fact that this can be best achieved by social marketing campaigns to promote demand of ITNs. The messages should be tailored to cultural beliefs, for example the belief in some communities that mosquitoes have no role in the etiology of malaria. Distribution of ITNs to the community should ideally be followed by 'hang up' campaigns by trained health care workers educating the community on how to use the nets and helping them hang the nets, especially for the most vulnerable groups. (b) The community empowerment efforts, a collaborative initiative with the community to understand the cultural beliefs and behaviours and educating them about the disease would produce desirable results. There are documented examples of how women in a community empowerment program in Thailand developed family malaria protection plans, provided malaria education to community members, mosquito-control measures in a campaign, scaled-up use of insecticide-impregnated bed nets, instituted malaria control among migrant labourers, as well as activities to raise income for their families. Another program in Papua New Guinea empowered community members to take responsibility for the procurement, distribution and effective use of bed nets in the village, which led to a significant decrease in the incidence of malaria-related mortality and morbidity. (c) Strengthen health systems, integration of malaria vector control and personal protection into the health system through innovative linkages to ongoing health programs and campaigns is likely to lead to strong synergies, economies, and more rapid health system strengthening compared to new vertical programmes.. Successful examples of this include piggybacking the distribution of ITNs through antenatal care or immunization campaigns for measles and polio. (d) Partnerships are key in malaria control because of the involvement of multiple sectors. Action outside the health sector to remove barriers to the uptake of malaria prevention strategies has included lobbying for reduction or waiver of taxes and tariffs on mosquito nets, netting materials and insecticides and stimulating local ITN industries. Intersectoral collaboration has played an integral role in vector control measures for malaria prevention, including environmental modification, larval control, etc. [17]

   Noncommunicable Diseases Top

In NCDs, two path-breaking studies need special mention. These studies are the Framingham Heart Study (started in 1951) and study on smoking among British doctor (started in 1948) have helped us in understanding how lifestyle affects various NCDs. The study in British doctors showed that prolonged cigarette smoking from early adult life tripled age-specific mortality. The excess mortality associated with smoking mainly involved vascular, neoplastic and respiratory diseases caused by smoking. The Framingham Heart Study has led to the identification of major CVD risk factors such and blood pressure, blood triglycerides and cholesterol level, age, gender and psychosocial issues (Framingham Heart Study). [18]

   Cardiovascular Diseases Top

In the early 1970s the mortality rate from coronary heart disease was the highest in the world among men of Finland. The dietary practices of the Finnish population centered around dairy products and their food was rich in saturated fats, salt and low in unsaturated fats, fruits and vegetables. The North Karelia project, a major community-based intervention was launched in North Karelia, a fairly rural and economically poor province. This project developed comprehensive community based strategies to change the dietary habits of the population, with the main goal to reduce the high cholesterol levels in the population. The strategy focused on reduction intake of high saturated fat as well as the salt intake and to increase the consumption of fruits and vegetables. At the individual and community level, health information and nutritional counseling were made available, skills were developed, social and environmental support was provided all the while ensuring community participation. The health system was closely involved with the project. The project also developed strong partnerships with schools, health related and other nongovernmental organizations, supermarkets and food industry, community-based organizations and media. Collaborations were done with the food industry to reduce the fat and salt content of common food items such as dairy food, processed meat and bakery items. Dairy farmers were encouraged to switch to berry farming through the launching of a Berry project. The North Karelia project was extended to the entire country with the health care services also responsible along with schools and nongovernmental agencies in implementing nutrition and health education. Nation-wide nutrition education and collaboration with food industry were backed by legislative actions and were rewarded with remarkable results. Surveys showed a transformation in dietary habits with a marked reduction intake in saturated fats and salt and declared ischemic heart disease mortality declining by 73% in North Karelia and by 65% in Finland from 1971 to 1995. [19]

   Diabetes Mellitus Top

Diabetes mellitus is one of the NCDs which has led to high rates of morbidity and mortality worldwide. Health promotion is being increasingly recognized as a viable, cost-effective strategy to prevent diabetes. The interventions at the individual and community level includes lifestyle modification programs for weight control and increasing physical activity with community participation using culturally appropriate strategies. The Kahnawake School's Diabetes Prevention Project (KSDPP) in Canada provides an example of a project that involved the local Mohawk community, researchers and local health service providers, in response to requests from the community to develop a diabetes prevention program for young children. The long-term goal of KSDPP was to decrease the incidence of type 2 diabetes, through the short-term objectives of increasing physical activity and healthy eating. Such preventive interventions have to be backed by strengthening of the health system which combines identification of high risk groups with risk factor surveillance and availability of trained primary health care providers for risk assessment and diabetes management. Online training courses offer an innovative approach to enhance health system capacity for diabetes health promotion, such as a course targeted at workers in remote indigenous communities in the Arctic to foster learning related to the Nunavut Food Guide, traditional food and nutrition, and diabetes prevention. Partnership and network development is key to the achievement of these measures. As part of the city-wide 'Let's Beat Diabetes initiative' in South Auckland, New Zealand the district health board with support from local government provided safe environments for physical activity by upgrading parks and worked with the food industry to provide healthier food options at retail outlets in order to reduce consumption of sweetened soft drinks and energy dense foods. Sugar-free soft drinks were made available as default options to customers, unless specifically requested otherwise. Intersectoral action on risk factors for diabetes also acts on the determinants of the other major risk factors for the NCD burden, such as heart disease, cancer and respiratory disease, hence health promotion activities aimed at reducing risk of diabetes mellitus have added advantages. [17]

   Settings Based Approach to Health Promotion Top

The concept of 'healthy settings' which maximizes disease prevention through a whole system approach had emerged from WHO's Health for All strategy and Ottawa Charter. The call for supportive environments was followed up by the Sundwal statement of 1992 and the Jakarta declaration of 1997. The settings approach builds on the principles of community participation, partnership, empowerment and equity and replaces an over reliance on individualistic methods with a more holistic and multidisciplinary approach to integrate action across risk factors. The 'Healthy Cities' programme launched by WHO in 1986 was soon followed up by similar initiatives in smaller settings such as schools, villages, hospitals, etc. [20]

   Health Promoting Schools Top

Health promoting schools build health into all aspects of life in school and community based on the consideration that health is essential for learning and development. To further this concept, WHO and other UN agencies developed an initiative, 'Focusing Resources on Effective School Health (FRESH), emphasizing on the benefit to both health and education if all schools were to implement school health policies, a healthy school environment, with the provision of safe water and sanitation an essential first step, skills-based health education and school-based health and nutrition services. [21]
   Healthy Work Places Top

Currently, globally an estimated two million people die each year as a result of occupational accidents and work-related illnesses or injuries and 268 million nonfatal workplace accidents result in an average of three lost workdays per casualty, as well as 160 million new cases of work-related illness each year. [22] Healthy work places envision building a healthy workforce as well as providing them with healthy working conditions. Healthy working environments translate to better health outcomes for the employees and better business outcomes for the organizations. [23]

   Health Promotion in India Top

Health promotion is strongly built into the concept of all the national health programs with implementation envisaged through the primary health care system based on the principles on equitable distribution, community participation, intersectoral coordination and appropriate technology. Nevertheless, it has received lower priority compared to clinical care. The government, through the component of IEC has always strived to address the issue of lack of information, which is a major barrier to increasing accessibility of health care services. [24] The National Rural Health Mission (NRHM) called for a synergistic approach by relating health to determinants of good health such as segments of nutrition, sanitation, hygiene and safe drinking water and by revitalizing local traditions and mainstreaming the Ayurvedic, Unani, Siddha and Homeopathic systems of medicine to facilitate health care. [25] NRHM offers an excellent opportunity to target and reach every beneficiary with appropriate interventions through microplanning into district planning process. [26]

Health promotion component needs to be strengthened with simple, cost-effective, innovative, culturally and geographically appropriate models, combining the issue-based and settings-based designs and ensuring community participation. Replicability of successful health promotion initiatives and best practices from across the world and within the country needs to be assessed. Efforts have already been initiated to build up healthy settings such as schools, hospitals, work places, etc. [20],[22],[27] For effective implementation of health promotion we need to engage sectors beyond health and adopt an approach of health in all policies rather than just the health policy.

   Conclusions Top

Today, there is a global acceptance that health and social well being are determined by a lot of factors which are outside the health system which include inequities due to socioeconomic political factors, new patterns of consumption associated with food and communication, demographic changes that affect working conditions, learning environments, family patterns, the culture and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change. To counter the challenges due to the changing scenarios such as demographic and epidemiological transition, urbanization, climate change, food insecurity, financial crisis, etc. health promotion has emerged as an important tool; nevertheless the need for newer, innovative approaches cannot be understated. A multisectoral, adequately funded, evidence-based health promotion program with community participation, targeting the complex socioeconomic and cultural changes at family and community levels is the need of the hour to positively modify the complex socioeconomic determinants of health.

   References Top

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7 Health-promoting university: the implementation of an integrated guidance post for non-communicable diseases (Posbindu PTM) among university employees
Tri Siswati, Margono, Novi Husmarini, Yuliasti Eka Purnamaningrum, Bunga Astria Paramashanti
Global Health Promotion. 2021; : 1757975921
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8 Health knowledge and care seeking behaviour in resource-limited settings amidst the COVID-19 pandemic: A qualitative study in Ghana
Farrukh Ishaque Saah, Hubert Amu, Abdul-Aziz Seidu, Luchuo Engelbert Bain, Kingston Rajiah
PLOS ONE. 2021; 16(5): e0250940
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9 Development of Students’ Value Attitude to Their Own Health in the Process of Physical Education Under Quarantine
Viktor Koryahin, Oksana Blavt
Journal of Learning Theory and Methodology. 2021; 2(2): 53
[Pubmed] | [DOI]
10 Maximizing Millennial Students Role in Combating COVID-19 Hoaxes and Myths
Astri Dewayani, Euvanggelia Dwilda Ferdinandus, Rizki Putra Prastio, Indah Fahmiyah, Amila Sofiah, Rodik Wahyu Indrawan, Mochammad Nurul, Gagas Gayuh Aji, Nanda Rachmad Putra Gofur, Siti Khaerunnisa, Dewi Sriani, Yankel Sena
Biomolecular and Health Science Journal. 2021; 4(1): 42
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11 Water, sanitation, and hygiene for schistosomiasis prevention: a qualitative analysis of experiences of stakeholders in rural KwaZulu-Natal
Chanelle Mulopo, Moses J. Chimbari
Journal of Water, Sanitation and Hygiene for Development. 2021; 11(2): 255
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12 Digital Health Intervention to Increase Health Knowledge Related to Diseases of High Public Health Concern in Iringa, Tanzania: Protocol for a Mixed Methods Study
Christine Holst, Felix Sukums, Bernard Ngowi, Lien My Diep, Tewodros Aragie Kebede, Josef Noll, Andrea Sylvia Winkler
JMIR Research Protocols. 2021; 10(4): e25128
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13 Development of Digital Health Messages for Rural Populations in Tanzania: Multi- and Interdisciplinary Approach
Christine Holst, Ghislain Maurice Norbert Isabwe, Felix Sukums, Helena Ngowi, Flora Kajuna, Danica Radovanovic, Wisam Mansour, Elibariki Mwakapeje, Peter Cardellichio, Bernard Ngowi, Josef Noll, Andrea Sylvia Winkler
JMIR mHealth and uHealth. 2021; 9(9): e25558
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14 Knowledge of Zika Virus Transmission and Its Prevention among High-Risk Pregnant Women in Brazil
Lucas C. Pires, Luiza R. Dantas, Steven S. Witkin, Ana Paula A. P. Bertozzi, Rita de Cássia A. B. Dezena, Maria M. D. Rodrigues, Rosa Estela Gazeta, Saulo D. Passos
Viruses. 2021; 13(2): 242
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15 Lay Public View of Neuroscience and Science-Based Brain Health Recommendations in Slovenia
Nastja Tomat, Matej Perovnik, Gaj Vidmar, Vesna van Midden, Sara Fabjan, Hana Hawlina, Dolores Trol, Alina Holnthaner, Sebastijan Krajnc, Maruša Grešak, Liza Žerdin, Judita Vidmar, Mara Bresjanac
Frontiers in Public Health. 2021; 9
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16 Perception and Knowledge of Patients from Different Regions in the Kingdom of Saudi Arabia towards Oral Hygiene and Oral Hygiene Aids
Shamoukh Alshahrani, Abrar Alshuaibi, Malak Alkhaldi, Pradeep Koppolu
Healthcare. 2021; 9(5): 592
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17 The Effect of Health Promotion Educational Interventions on Self-Care Behaviors of Nutrition and Physical Activity Among Universities Staff in Southeastern Iran
Fariba Shahraki Sanavi, Mahdi Mohammadi, Maryam Seraji, Hassan Okati-Aliabad
Health Scope. 2021; 10(4)
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18 Predictors of Observance of Preventive Behaviors toward Crimean-Congo Hemorrhagic Fever by Butchers in Qom City in Central Iran
Zeynab Karimi, Shadi Fathizadeh, Zabihollah Gharlipour, Abedin Saghafipour, Samaneh Abolkheirian
Shiraz E-Medical Journal. 2021; In Press(In Press)
[Pubmed] | [DOI]
19 Shifting the Paradigm: The Dress-COV Telegram Bot as a Tool for Participatory Medicine
Michela Franchini,Stefania Pieroni,Nicola Martini,Andrea Ripoli,Dante Chiappino,Francesca Denoth,Michael Norman Liebman,Sabrina Molinaro,Daniele Della Latta
International Journal of Environmental Research and Public Health. 2020; 17(23): 8786
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20 Strategies to improve mental health and well-being within the UK construction industry
Marc A Campbell,Joseph G Gunning
Proceedings of the Institution of Civil Engineers - Management, Procurement and Law. 2020; 173(2): 64
[Pubmed] | [DOI]

Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries

Mainul Haque,Tariqul Islam,Nor Azlina A Rahman,Judy McKimm,Adnan Abdullah,Sameer Dhingra
Risk Management and Healthcare Policy. 2020; Volume 13: 409
[Pubmed] | [DOI]
22 The Effect of Quality Service Towards Outpatients Satisfaction at Poasia Community Health Centre
Adryan Fristiohady,La Ode Muhammad Fitrawan,Yusniati Dwi Pemudi,Ruslin Ruslin,Sunandar Ihsan,Ruslan Ruslan,La Ode Muhammad Julian Purnama
Borneo Journal of Pharmacy. 2020; 3(4): 270
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23 Health education improves referral compliance of persons with probable Diabetic Retinopathy: A randomized controlled trial
Zara Khair,Md Moshiur Rahman,Kana Kazawa,Yasmin Jahan,Abu S. G. Faruque,Mohammod Jobayer Chisti,Michiko Moriyama,Antonio Palazón-Bru
PLOS ONE. 2020; 15(11): e0242047
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24 The role of local and regional authorities in prevention and control of NCDs: the case of Poland
Robert Tabaszewski
BMC International Health and Human Rights. 2020; 20(1)
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25 The psychometric properties of the Italian adaptation of the Health Orientation Scale (HOS)
M. Masiero,S. Oliveri,I. Cutica,D. Monzani,F. Faccio,K. Mazzocco,G. Pravettoni
Health and Quality of Life Outcomes. 2020; 18(1)
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26 Applicability of health promoting lifestyle profile-II for postmenopausal women in Sri Lanka; a validation study
Nirmala Rathnayake,Gayani Alwis,Janaka Lenora,Sarath Lekamwasam
Health and Quality of Life Outcomes. 2020; 18(1)
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27 Implementing without guidelines, learning at the coalface: a case study of health promoters in an era of community health workers in South Africa
Teurai Rwafa-Ponela,John Eyles,Nicola Christofides,Jane Goudge
Health Research Policy and Systems. 2020; 18(1)
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28 Effects of oral health promotion programmes on adolescents’ oral health-related quality of life: A systematic review
Aretuza Pires dos Santos Lattanzi,Flávia Maia Silveira,Ludmila Guimarães,Lívia Azeredo Alves Antunes,Leonardos Santos Antunes,Andrea Videira Assaf
International Journal of Dental Hygiene. 2020; 18(3): 228
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29 Mental Health Navigation – a Model
Gerald Knesek,Thomas Hemphill
Health Promotion International. 2020; 35(1): 151
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30 Content of Brazilian supermarket circulars do not reflect national dietary guidelines
Anice Milbratz de Camargo,Júlia Pitsch de Farias,Ana Claudia Mazzonetto,Moira Dean,Giovanna Medeiros Rataichesck Fiates
Health Promotion International. 2020; 35(5): 1052
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31 Exploring HIV-Related Stigma and Discrimination at the Workplace in Southwestern Uganda: Challenges and Solutions
Benedict Twinomugisha,Fungisai Gwanzura Ottemöller,Marguerite Daniel,Hamidreza Karimi-Sari
Advances in Public Health. 2020; 2020: 1
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32 Application of Disease Etiology and Natural History to Prevention in Primary Health Care: A Discourse
Franklin White
Medical Principles and Practice. 2020; 29(6): 501
[Pubmed] | [DOI]
33 Classification of elderly based on attitude for health promotive in Deli Serdang using machine learning approach
Masdalifa Pasaribu,Albiner Siagian,Rahayu Lubis,Dewi Ramadani,Rika Subarniati Triyoga,Etti Sudaryati
IOP Conference Series: Materials Science and Engineering. 2020; 851: 012044
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34 Mixed-methods approach to determine adherence, knowledge and behavioral determinants associated with medication wastage
Lorna Marie West,Derek Stewart,Maria Cordina
Research in Social and Administrative Pharmacy. 2020; 16(5): 654
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35 Objectives and Competencies in Food and Nutrition Education in the Brazilian Undergraduate Nutrition Program
Géssica Mercia de Almeida,Elisabetta Recine,Andhressa Fagundes
Journal of Nutrition Education and Behavior. 2020; 52(4): 385
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36 An online card-sorting study to inform the initial low-fidelity design of a crowdsourced health information system for individuals who have chronic health conditions seeking local health-related resources
Gagan Jindal
Human Behavior and Emerging Technologies. 2020; 2(2): 128
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37 The use of antimalarial plants as traditional treatment in Papua Island, Indonesia
Mery Budiarti,Anshary Maruzy,Rohmat Mujahid,Aniska Novita Sari,Wahyu Jokopriyambodo,Tri Widayat,Slamet Wahyono
Heliyon. 2020; 6(12): e05562
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38 Ottawa charter framework as a guide for type 2 diabetes prevention and control in Iran
Maryam Peimani,Ensieh Nasli-Esfahani,Elham Shakibazadeh
Journal of Diabetes & Metabolic Disorders. 2019; 18(1): 255
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39 Whole-body MRI for preventive health screening: A systematic review of the literature
Robert M. Kwee,Thomas C. Kwee
Journal of Magnetic Resonance Imaging. 2019; 50(5): 1489
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40 Rental Housing Needs and Barriers From the Perspective of Veterans With Disabilities
Luz Mairena Semeah,Sherry Ahrentzen,Diane C. Cowper-Ripley,Leslie M. Santos-Roman,Julia O. Beamish,Kristine Farley
Housing Policy Debate. 2019; 29(4): 542
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41 The Cultural Context for Communicating Care
Kirk St.Amant
Journal of Technical Writing and Communication. 2019; 49(4): 367
[Pubmed] | [DOI]
42 Participatory Monitoring and Evaluation of Ebola Response Activities in Lofa County, Liberia: Some Lessons Learned
Ithar Hassaballa,Stephen Fawcett,Charles Sepers,Florence DiGennaro Reed,Jerry Schultz,Davison Munodawafa,Peter M. Phori,Ephraim Chiriseri,Koffi Kouadio
International Quarterly of Community Health Education. 2019; 40(1): 57
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43 Influence of workplace incivility on the quality of nursing care
Abdualrahman Saeed Alshehry,Nahed Alquwez,Joseph Almazan,Ibrahim Mohammed Namis,Jonas Preposi Cruz
Journal of Clinical Nursing. 2019; 28(23-24): 4582
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44 Barriers to the implementation of sexual and reproductive health education programmes in low-income and middle-income countries: a scoping review protocol
Moreblessing Chipo Mashora,Tafadzwa Dzinamarira,Claude Mambo Muvunyi
BMJ Open. 2019; 9(10): e030814
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45 Secondhand smoking, knowledge/attitudes and socioeconomic status among married Bangladeshi women: a cross-sectional study
Mosiur Rahman,Sheikh Mohammad Mahmudul Hasan,Syed Emdadul Haque,Nuruzzaman Haque,Mosfequr Rahman,Golam Mostofa,Sarwar Zahan,Durrul Huda,Saber Al- Sobaihi,Kapil Ahmed,Howlader Mohammad Miraz Mahmud
Sao Paulo Medical Journal. 2019; 137(1): 13
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46 0-2 yas araliginda çocugu olan ebeveynlerin asilar hakkindaki düsünceleri
Ezgi Demirtürk Selçuk,Birsel Canan Demirbag
Cukurova Medical Journal. 2019; 44: 156
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47 The Challenges of the IS/IT Projects in the Healthcare Sector
Jorge Gomes,Mário Romão
International Journal of Applied Research on Public Health Management. 2019; 4(1): 67
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48 The effect of health promotion program on female breast self-examination knowledge and practice
ShereenAbd El-Moneam Ahmed,SherenElsayed Shrief
Egyptian Nursing Journal. 2019; 16(1): 25
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49 Leptospirosis Health Intervention Module Effect on Knowledge, Attitude, Belief, and Practice among Wet Market Workers in Northeastern Malaysia: An Intervention Study
Mas Rahman,Suhaily Hairon,Rukman Hamat,Tengku Jamaluddin,Mohd Shafei,Norazlin Idris,Malina Osman,Surianti Sukeri,Zainudin Wahab,Wan Mohammad,Zawaha Idris,Aziah Daud
International Journal of Environmental Research and Public Health. 2018; 15(7): 1396
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50 Head Lice Infestation (Pediculus humanus capitis) Prevalence and Its Associated Factors, Among The Kormanj Tribes in North Khorasan Province
Faranak Firoozfar,Seyed Hassan Moosa-Kazemi,Abbas Bahrami,Mustapha Ahmed Yusuf,Abedin Saghafipour,Zeynab Armoon,Rezvan Rajabzadeh,Seyed Hamid Hosseini
Shiraz E-Medical Journal. 2018; In Press(In Press)
[Pubmed] | [DOI]
51 Evaluating the Oral Health Knowledge and the Status of Visually Impaired Children using Braille
Sapna S Kudtarkar
Journal of Oral Health and Community Dentistry. 2018; 12(2): 41
[Pubmed] | [DOI]
52 Estudo comparativo de práticas de promoção da saúde na atenção primária em Florianópolis, Santa Catarina, Brasil e Toronto, Ontário, Canadá
Ivonete Teresinha Schulter Buss Heidemann,Camilla da Costa Cypriano,Denise Gastaldo,Suzanne Jackson,Carolina Gabriele Rocha,Eloi Fagundes
Cadernos de Saúde Pública. 2018; 34(4)
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53 The Relationship between Health-Promoting Lifestyle (HPL) and Academic Self-Efficacy among students
S Saadat,M Kalantari,MB Kajbaf
Research in Medical Education. 2018; 9(4): 38
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54 Towards a public health approach for palliative care: an action-research study focused on engaging a local community and educating teenagers
Sandra Martins Pereira,Joana Araújo,Pablo Hernández-Marrero
BMC Palliative Care. 2018; 17(1)
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55 Self-assessment of health promoting Hospital’s activities in the largest heart Hospital of Northwest Iran
M.-H. Taghdisi,S. Poortaghi,V. Suri-J,T. Dehdari,M. Gojazadeh,M. Kheiri
BMC Health Services Research. 2018; 18(1)
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56 Health dynamics in camps and on campuses: stressors and coping strategies for wellbeing among labourers and students in Cameroon
Valerie Makoge,Harro Maat,Lenneke Vaandrager,Maria Koelen
International Journal of Qualitative Studies on Health and Well-being. 2018; 13(1): 1435098
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57 Dietary intake and lifestyle behaviors of children in Mauritius
Digvijayini Bundhun,Sillma Rampadarath,Daneshwar Puchooa,Rajesh Jeewon
Heliyon. 2018; 4(2): e00546
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58 Health-promoting behaviors benefit the mental health of cirrhotic outpatients
Hui-Chuan Huang,Kuan-Chia Lin,Chia-Shin Wu,Nae-Fang Miao,Ming-Yao Chen
Quality of Life Research. 2018; 27(6): 1521
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59 Analyzing recommender systems for health promotion using a multidisciplinary taxonomy: A scoping review
Santiago Hors-Fraile,Octavio Rivera-Romero,Francine Schneider,Luis Fernandez-Luque,Francisco Luna-Perejon,Anton Civit-Balcells,Hein de Vries
International Journal of Medical Informatics. 2018; 114: 143
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60 Knowledge, usage and barriers associated with contact lens wear in Ghana
Samuel Abokyi,George Manuh,Heinz Otchere,Alex Ilechie
Contact Lens and Anterior Eye. 2017; 40(5): 329
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61 A treatise for a new philosophy of chiropractic medicine
Timothy A. Mirtz
Chiropractic & Manual Therapies. 2017; 25(1)
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62 The impact of health promotion on trachoma knowledge, attitudes and practice (KAP) of staff in three work settings in remote Indigenous communities in the Northern Territory
Fiona D. Lange,Kelly Jones,Rebecca Ritte,Haley E. Brown,Hugh R. Taylor,Jeremiah M. Ngondi
PLOS Neglected Tropical Diseases. 2017; 11(5): e0005503
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63 Snacking in children according to age
P. Pac,A. Gladka,M. Maciorkowska,M. Zalewska,P. Musialowski,M. Zakrzewski,E. Maciorkowska
Progress in Health Sciences. 2017; 7(1): 107
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64 Public Health Campaigns and Medicine Use Awareness: A Systematic Literature Review
Mahsa Ranjbar,Zoe Aslanpour,Andrzej Kostrzewski,Andrew David Cooke
Health. 2017; 09(12): 1689
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65 Associations between a health-promoting lifestyle and quality of life among adults with beta-thalassemia major
Aghbabak Maheri,Roya Sadeghi,Davoud Shojaeizadeh,Azar Tol,Mehdi Yaseri,Mojtaba Ebrahimi
Epidemiology and Health. 2016; 38: e2016050
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66 How Health Behaviour Affects Depression Across Different Age and Gender Cohorts in India?
Reshmi Sengupta
SSRN Electronic Journal. 2016;
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67 The Impact of Setting the Standards of Health Promoting Hospitals on Hospital Indicators in Iran
Mohammad Amiri,Ahmad Khosravi,Leila Riyahi,Shima Naderi,Saravana Kumar
PLOS ONE. 2016; 11(12): e0167459
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68 result 1 Document Introduction to strategic management and leadership for health professionals
Authors of Document Kumar, S., Adhish, V.S., Deoki, N.
Source of the Document Indian Journal of Community Medicine. 2014;
69 Designing and Costing of an Adaptable and Flexible Essential Health Package (EHP) for Indian States
Pallav Bhatt,Varada Madge,Nachiket Mor,Vinod Paul,Navneet Jain,Subhash Hira,Priya Balasubramaniam
SSRN Electronic Journal. 2014;
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70 Health Promotion in Ecuador: A Solution for a Failing System
Dana Rasch,Krista Bywater
Health. 2014; 06(10): 916
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71 The Impact of Educational Intervention Based on Empowerment Model in Preventing Violence Against Women
Mohammad Hossein Taghdisi,Marzieh Latifi,Maryam Dastoorpour,Ensiyeh Jamshidi,Fatemeh Estebsari,Fiesal Jamalzadeh
Iranian Red Crescent Medical Journal. 2014; 16(7)
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72 result 2 Document Factors associated with dengue prevention and control in two villages in a central thai province: A retrospective review
Thakolwiboon, S., Benjatikul, N., Sathianvichitr, K., (...), Assantachai, P., Homsanit, M.
Journal of the Medical Association of Thailand. 2013;


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