An evaluation of the use and impact of health promotion competencies in Europe
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Introduction -While competency-based approaches have been developed in Health Promotion over the past three decades there has been limited focus on the evaluation of their use and impact. Five years after publication of the CompHP Core Competencies Framework for Health Promotion this study was initiated with the aim of evaluating its use and impact on Health Promotion practice, education and training in Europe. Methods - The study incorporated a scoping review of the literature (Phase 1), and a two-phase mixed-methods study. In Phase 2, an online survey tool was employed. The purposive sample comprised health promoters who had contributed to the development of the competencies, augmented by snowball sampling across European Health Promotion practitioners. Phase 3 comprised a single case study with two embedded units of analysis, namely the countries of Ireland and Italy. The sample initially involved five known Health Promotion experts in each country who acted as National Reference Groups and helped to identified additional key informants. The methods employed comprised a desk review of the contexts within which Health Promotion was practised in each country, followed by semi-structured interviews. Collection and thematic analysis of the data from each country was conducted separately, with the initial findings compared and reviewed by the national experts. Results - The literature review identified current Health Promotion competency frameworks and factors that were perceived as influencing their uptake and use, providing a context for the investigative phases of the study. There was a total of 81 responses to the online survey. Despite generally positive attitudes and high levels of reported Health Promotion capacity just over half of respondents (54%) reported that they had used the competencies in their practice and 53% that they were used in their country. Expectations that levels of resources, support and attitudes would influence the use of the competencies were generally met. A reported lack of support for, and formal recognition of, the competencies by key stakeholders emerged as a potentially critical factor influencing their uptake. In Phase 3 a total of 13 interviews were completed in each country. The focus and rate of progress of implementing the competencies was found to differ across the two countries, reflecting their levels of Health Promotion infrastructure and capacity. A lack of awareness of the competencies was identified as a major limiting factor to implementation in both countries, of particular concern in relation to key stakeholders. Conclusions The findings of the study, although limited by a low response rate in the online survey, provide important insights into the use and impact of the competencies on Health Promotion practice, education and training in Europe, together with in-depth analysis of the factors influencing their implementation at individual practitioner and country levels. Findings regarding a lack of awareness of the competencies at all levels, and perceptions that their implementation is not supported by key stakeholders, highlight the importance of advocacy, dissemination and marketing to ensure future implementation. The findings provide useful insights for future implementation and begin to address the gap in empirical evidence on the use and impact of Health Promotion competencies, while indicating the need for further research.