Vernetzen und kooperieren in der Gesundheitsförderung : Konzeptionelle Grundlagen, Strukturen und praktische Erfahrungen = Networking and collaboration in health promotion : conceptual foundations, structures and practical experience

Networking and collaboration are key elements of health promotion. The complexity of these tasks results from the basic idea, that health promotion is a societal challenge: The state, the economic sector and citizens are necessary partners in creating healthy lifestyles and healthy environments. After a short introduction (1) my paper will give insights into the conceptual and theoretical background (2), highlight the essential structures, metaphorically called „bridging structures“ (3) and their functions according to the Ottawa-Charta (4). This is followed by some empirically based recommendations that can guide practitioners of health promotion (5) and criteria for good practice in networking and collaboration (6). I conclude with some remarks on present health policies (7). These are written from a German perspective but might apply in other countries as well

Patient-Centered Medicine and Self-Help Groups in Germany: Self-Help Friendliness as an Approach for Patient Involvement in Healthcare Institutions

Collaboration between laypersons and professionals is closely linked to the concept of patient centeredness. Patient centeredness means meeting the needs of individual patients as well as reacting to patients’ demands on the collective level. The support of self-help groups and their integration into healthcare institutions represent a major policy approach to fulfilling this requirement. Here, we first deal with the concept of patient centeredness in general, and the understanding of concept and use in Germany. We also provide a short definition of self-help friendliness (SHF) and discuss the success achieved in implementing it in Germany so far. We then clarify the closely related concepts of patient centeredness, patient participation and patient involvement SHF is seen as a strategy for increasing both patient centeredness and patient participation in healthcare services. We subsequently describe the involvement of self-help groups and patient associations in a series of empirical studies and practice-oriented projects carried out between 2004 and 2013. The last section contains a general discussion of the SHF approach as a means of systematically increasing sustainable patient centeredness and patient participation in healthcare services. Finally, we address the chances for future development in Germany and the transferability of SHF to other countries

Methodenvielfalt in der Gesundheitsforschung

Dem von einem an Experimenten und Statistik orientierten, akademischen Methodenverständnis wird eine praxisorientierte Methodenvielfalt in der Gesundheitspsychologie kritisch gegenübergestellt. Auf die Notwendigkeit experimenteller Ursachen-Wirkungs-Forschung und epidemiologischer Forschung wird als unverzichtbaren Bestandteil der Gesundheitsforschung hingewiesen, jedoch wird betont, daß die akademische Einengung wissenschaftlicher Forschung auf diese Methoden verhängnisvoll sei. Verschiedene qualitative Forschungsansätze werden vorgestellt: Grounded Theory, Aktionsforschung, Organisationsentwicklung, Qualitätsmanagement, Evaluationsforschung, Technikfolgeabschätzung und Policyforschung.The experiment and statistics oriented academic methodological comprehension is critically contrasted with a practice-oriented methodological variety in public health research. The necessity of experimental stimulus-response-research and epidemiological research in public health research is pointed out. Nevertheless, it is emphasized that it might be fateful to narrow scientific research to these methods. A variety of qualitative research methods, important in the area of public health, is introduced: Grounded Theory, action research, organization development, Total Quality Management, evaluation research, risks of technology development, and policy research

Participation as a Core Principle of Community Health Promotion: General Account and Examples

One of the key principles of the Ottawa Charta is participation. Community health interventions should involve the community, i.e., residents and local actors. In Hamburg, we tried to put this principle into practice during a project initiated by the municipal health service in a disadvantaged quarter with about 3000 inhabitants. The contribution starts with an account of the meaning of participation in health promotion (1) and gives an overview of participation methods in general (2). The next part contains a short account of our project (3). Five examples are presented in part four: a survey with key actors and two approaches to listening to residents’ perceptions of capacity building in the neighborhood. Another survey of residents was meant to explore the use of health promotion offers and the preparedness to get involved. The last example is the round table of local actors as a sort of steering committee for health promotion interventions (4). Key findings of the examples are: Surveys do result in valuable information for the local actors. The expressed willingness to participate is larger than the actual participation. Opportunities to participate (in surveys and at the round table) are welcome by local actors. In the last section we discuss the advantages, problems and some illusions concerning participation in health promotion (5)

Soziale Stadtentwicklung und Gesundheitsförderung

Es wird der Frage nachgegangen, wie sich die politischen Projekte "Gesundheitsförderung" und "soziale Stadtentwicklung" im Rahmen intersektionaler Politik wechselseitig stärken können. Zu diesem Zweck werden Dokumente und Sekundärliteratur aus den beiden entsprechenden Politikbereichen ausgewertet. Zuerst wird das Programm "Gesundheitsförderung" nachgezeichnet. Es betont die Veränderung von sozialen Verhältnissen und Umweltverhältnissen. Parallel zu dieser Entwicklung gewinnt in vielen westeuropäischen Städten das inhaltlich ähnliche Projekt "soziale Stadtentwicklung" an Bedeutung. Die programmatischen Gemeinsamkeiten beider Projekte hinsichtlich Leitbildern, Globalzielen, Prozessorientierung, intersektoralem Politikanspruch sowie sozialer Ungleichheit als Handlungsschwerpunkt werden herausgearbeitet. Es wird deutlich, dass trotz der großen inhaltlichen Nähe praktisch und politisch kaum kooperiert wird. Diese Aussage gilt insbesondere für sozial bedingte Gesundheitsrisiken. In beiden Bereichen werden diese in der Umsetzung erheblich weniger berücksichtigt als umweltbedingte Probleme. Die Bekämpfung von sozialen Problemen wie Armut und Benachteiligung, dargestellt am Beispiel Hamburgs, ist beiden Fachressorts von ihren Arbeitsweisen her gleichermaßen wesensfremd und daher weniger anschlussfähig als die Berücksichtigung der stofflich greifbareren und leichter messbaren Umweltrisiken. Abschließend wird diskutiert, wie Gesundheitsförderung im Rahmen sozialer Stadtentwicklung weiterentwickelt werden kann und welche Probleme und Chancen der Umsetzung damit verknüpft sind

A comparison of conventional and retrospective measures of change in symptoms after elective surgery

<p>Abstract</p> <p>Background</p> <p>Measuring change is fundamental to evaluations, health services research and quality management. To date, the Gold-Standard is the prospective assessment of pre- to postoperative change. However, this is not always possible (e.g. in emergencies). Instead a retrospective approach to the measurement of change is one alternative of potential validity. In this study, the Gold-Standard 'conventional' method was compared with two variations of the retrospective approach: a perceived-change design (model A) and a design that featured observed follow-up minus baseline recall (model B).</p> <p>Methods</p> <p>In a prospective longitudinal observational study of 185 hernia patients and 130 laparoscopic cholecystectomy patients (T0: 7-8 days pre-operative; T1: 14 days post-operative and T2: 6 months post-operative) changes in symptoms (Hernia: 9 Items, Cholecystectomy: 8 Items) were assessed at the three time points by patients and the conventional method was compared to the two alternatives. Comparisons were made regarding the percentage of missing values per questionnaire item, correlation between conventional and retrospective measurements, and the degree to which retrospective measures either over- or underestimated changes and time-dependent effects.</p> <p>Results</p> <p>Single item missing values in model A were more frequent than in model B (e.g. Hernia repair at T1: model A: 23.5%, model B: 7.9%. In all items and at both postoperative points of measurement, correlation of change between the conventional method and model B was higher than between the conventional method and model A. For both models A and B, correlation with the change calculated with the conventional method was higher at T1 than at T2. Compared to the conventional model both models A and B also overestimated symptom-change (i.e. improvement) with similar frequency, but the overestimation was higher in model A than in model B. In both models, overestimation was lower at T1 than at T2 and lower after hernia repair than after cholecystectomy.</p> <p>Conclusions</p> <p>The retrospective method of measuring change was associated with a larger improvement in symptoms than was the conventional method. Retrospective assessment of change results in a more optimistic evaluation of improvement by patients than does the conventional method (at least for hernia repair and laparoscopic cholecystectomy).</p

Integrierte Gesundheitsberichterstattung auf Landes- und kommunaler Ebene: Initiativen und Ansätze der letzten 20 Jahre

The Ottawa Charter produced a new paradigm of health promotion, putting forward concepts such as intersectoral policies, determinants of health, and mediating. In this framework, the demand was made that health reports should be conceptualized as integrative, containing data from all sectors where health determinants can be found. The research question is: Can we identify explicit concepts and a publicly communicated practice of integrated health reporting in the German-speaking countries? In order to answer this question, a web search was carried out and supplemented by emailed inquiries to key project personnel.Eight projects were identified: four projects/initiatives represented local or regional integrated health reporting; in North Rhine-Westphalia there were two initiatives started by the federal state but relating to local reporting; in Berlin (Germany) and Burgenland (Austria) we found reports for the federal states. The projects are presented in compressed form. Limitations of this explorative research are its restriction to reports explicitly labeled as 'integrative' and the narrowly defined search terms.Positive findings were good indicator concepts, some legal frameworks, and other promotive factors, such as scholarly support. However, there are shortcomings in putting integrative reporting into practice. Barriers might be the complexity of programs, missing financial, personal, and professional resources, organizational and methodical problems, as well as anxieties and prejudices. Some examples show that the barriers can be overcome. The guideline 'Good Practice Health Reporting' supports the call for integrated reporting explicitly, however too much is hidden in the document

‘Lenzgesund’: A Long-Term Community Health Promotion Programme in a Deprived Neighbourhood and Its Evaluation

The contribution will present a highly visible health promotion programme in a deprived urban neighbourhood, initiated in 2004 by the health authority of the Hamburgian district Eimsbüttel. Its focus was on capacity building in cooperation with local actors/parties and residents. During 2005 and 2017, the programme, called ‘Lenzgesund’, was researched by a team of the Institute of Medical Sociology. The research aimed at giving feedback to the actors about how well they achieved their goals. For this purpose, we had to develop and test new approaches to evaluation. KEQ (Kapazitätsentwicklung im Quartier/capacity building in residential quarters/neighbourhoods) is the acronym of a newly developed questionnaire for measuring community capacities being considered as relevant for health. KEQ can be seen as an intermediate outcome parameter for health promotion programmes and activities on the community level. Another innovative approach to evaluation was an audit of the programme through experts from outside Hamburg in order to have a more neutral external view. The first paragraphs will present the practical programme and its development in phases from 2004 to 2012. In the second part, we will give a short account of the two main approaches to long-term evaluation of the programme