Building on a foundation: strategies, processes and outcomes of health promotion in primary health care settings

Abstract

Jurisdictions around the world have articulated the need for the development of an integrated health care system with an increased emphasis on primary health care that incorporates the principles/practices of health promotion. Over the past century, the medical model has been the default model of care in many countries, and yet treatment alone is unlikely to have marked effects on health inequities or health status. This article presents and discusses three fundamental dimensions (strategies, processes and outcomes) of health promotion in primary health care (HP in PHC) settings. We argue that the three dimensions are founded on the values and structures of health promotion (Frankish et al., 2006). Our work is based on a comprehensive literature review, validation by key informants and a national survey of Canadian primary health care settings. We suggest that the strategies (types of interventions), processes (client and community centred care), and desired health promotion outcomes (intended or unintended results) need to be better articulated and understood. Identification and discussion of the domains of HP in PHC settings is a crucial first step. It is a step toward the subsequent identification of related indicators and measures of health promotion that can be used for planning, implementation and evaluation of important health promotion initiatives.