Health promotion research: dilemmas and challenges

OBJECTIVE—To analyse dilemmas and challenges in health promotion research, and to generate ideas for future development.
METHOD—The analysis is based on authors' experiences in working in the field of research and action in health promotion and on experiences of others as found in literature.
RESULTS—The assumptions underlying scientific research as based in the biomedical design are difficult to meet in community-based health promotion research. Dilemmas are identified in relation to the possibility of defining the independent and dependent variables beforehand and the intermingling of these variables (the intervention and outcome dilemma), the difficulty in quantifying the desired outcomes (the number dilemma), and the problem of diffusion of the programme to the control group (the control group dilemma).
CONCLUSION—Research in health promotion has specific reasons to reconsider the approach towards research, the selection of outcome variables, and research techniques. Strategies and methods to make activities and their outcomes clear are discussed and criteria to judge confidence and applicability of research findings are presented.


Keywords: health promotion research; research dilemmas; research challenge

Tales of logic : a self-presentational view on health-related behaviour

This dissertation questions the informational approach to health education. Many health education programmes are conducted with the implicit assumption that providing individuals with relevant information about the consequences of unhealthy behaviour will lead to a healthier way of life. Evaluations of health education programmes show, however, that rational cognitive appeals often do not seem to possess enough power to motivate people to change their behaviour. This study examines the extent to which health-related behaviour can be explained by the wish to be accepted by others.Two theories are described: attribution theory and self-presentation theory. In attribution theory it is assumed that individuals are logical information processors. By means of 'naive scientific' analysis of available information, the individual tries to obtain a veridical view of reality. Self-presentation theory assumes that individuals are motivated to create an impression on significant others that will lead to approval and avoid disapproval, by means of, for example, overt behaviours such as expressed opinions and dressing. The results of two experiments show that individuals use attribution statements for self-presentaional goals. When an actor perceives that others cannot easily repudiate a boosted self-presentation, the actor tries and succeeds to impress on others by self-enhancing attributions. When others do have access to possible repudiating information, actors' attribution statements are accurate.Subsequently, self-presentation theory is applied to health-related behaviour. In two field studies the assumption of many anti-smoking campaigns that smoking adolescents are less capable to resist peer pressure than nonsmoking adolescents is questioned. Self-presentation theory appeared to contribute to a fuller understanding of the working of peer pressure. Peer pressure is related to lifestyles, and it should be conceived of as a twoway influence process, in which it is rewarding for both the individual and the group to act in accordance with existing group norms. Peer pressure is equally strong for smokers, intenders and non-smokers.The results of the four studies show that behaviour often is guided more by self-presentational concerns than by concerns for cognitive consistency. The results of the studies can facilitate a more effective use of the influence of the social environment in health education

Parental child-feeding strategies in relation to Dutch children's fruit and vegetable intake

Objective: To identify parental child-feeding strategies that may increase children's fruit or vegetable intake, since the relationship between these strategies and children's intake has never been investigated for fruit and vegetables as two separate food groups. Design: A survey study, where parents provided information about their practices in relation to feeding their children and about their own and their children's fruit and vegetable intake. Children completed a preference questionnaire about fruit and vegetables. To find underlying parental child-feeding strategies, factor analysis was applied to parents' practices in relation to fruit and vegetables separately. Regression analysis was used to predict the effect of these strategies on children's fruit and vegetable intake. The impact of the strategies was further analysed by estimating children's intake based on the frequency of use of specific strategies. Setting: The study was conducted at three primary schools in The Netherlands. Subjects: A total of 259 children between 4 and 12 years old and their parents (n242). Results: Parents used different strategies for fruit as compared with vegetables. The vegetable-eating context was more negative than the fruit-eating context. Parental intake and presenting the children with choice were positive predictors of children's intake of both fruit and vegetables. The intake difference based on frequency of use of the strategy 'Choice' was 40 g/d for vegetables and 72 g/d for fruit (

Sociaal draagvlak : verslag van de uitwerking van 'sociaal draagvlak' voor het pilot project Referentiekader Gezondheidsbevordering

Sociaal draagvlak is uitgewerkt aan de hand van de begrippen participatie en samenwerken. Immers, door participatie en door samenwerking ontstaat sociaal draagvlak. Dit is een belangrijke reden dat in zogeheten community-based programma’s op het terrein van gezondheidsbevordering zowel participatie als samenwerken als essentiële elementen opgenomen worden. In verschillende stappen komen aan bod: het definiëren en operationaliseren van sociaal draagvlak, het in kaart brengen van de werkwijzen en meetinstrumenten om sociaal draagvlak te meten en te evalueren, het (verder) ontwikkelen van een aantal meetinstrumenten en het toetsen van deze meetinstrumenten in de praktijk