Domains of Core Competency in Health Promotion

[GBrennan]

In June 2008, the IUHPE participated in the Galway (Ireland) Consensus Conference, which aimed to promote global exchange and understanding concerning domains of core competency in the professional preparation and practice of health promotion and health education specialists. The Conference produced a draft Consensus Statement, intended for practitioners, academics in health promotion and health education, policy and decision-makers in government and non-governmental entities, employers and international organizations and other institutional authorities who have a stake and a responsibility in promoting the health of the public. The core values and principles, domains of core competency, and recommendations and key actions that are contained in the draft Consensus Statement are intended to be relevant for all countries.

Now, using the managed forum offered by the newly established IUHPE Views of Health Promotion Online (VHPO), the global health promotion community is invited to read the draft Consensus Statement, which is downloadable from this site, and comment on any and all aspects of the draft. The Consensus Conference participants are eager to have the opinions and ideas of the widest range of health promotion professionals, since the statement is meant to be relevant globally.

Your input will help guide the production of the final draft of the Statement. A summary of the dialogue will be published in IUHPE print journals, and the summary will also be placed on the agenda of the IUHPE Board of Trustees.

[Torill.Bull]

I find this to be an excellent initiative! Still, there is one sentence I struggle with:

The competencies required to engage in health promotion practice fall into eight domains

I think a clarification is needed - no one person can be expected to hold all these competencies, and I think it would be against our purposes to 'require' all these competencies before people 'engage' in health promotion practice. We work in teams, sharing strengths. I suspect the sentence is intended in a less 'strong' sense than what I read into it, but it might provoke the same reaction in others.

How 'competent' must a person be to engage in health promotion practices? In how many areas of competencies? I guess this is closely linked to the accreditation project currently going on, still I would wish for some modification/clarification regarding the cited sentence...

[Maurice Mittelmark]

Torill, you raise an interesting issue, and I do not remember this coming up at the Galway meeting. Thinking about it, there is the question of what level of competency one speaks about. Entry level competency versus higher levels of competency has not been a theme in the discussions so far. The USA's CHESS has a system of levels of competency, and I hope some CHESS members might comment on this topic. I must say that when I have been thinking about this, it has been at the entry level, meaning, for example, that every newly graduated health promoter with a master's degree should have familiarity with all the competency domains, if not substantial experience with any of them. Also, it is important to keep in mind that the Galway process is merely trying to define domains of competency, not the competencies themselves, or level, or how they are measured, etc.

[Torill.Bull]

Yes, I find it reasonable that this is a requirement for expected domains of competencies at master level. But health promotion practice is not necessarily understood as performed by people with a master's degree... so should the consensus be understood as relating to people with university degrees? Could the entrance level be lower? Who can be defined as health promotion practitioners?

[Larissa Kaminskyj]

The student group who attended the June Conference also wondered how one becomes a recognized ‘competent’ health promoter, and suggested that a five-step accreditation process may be a possible solution:

- Step 1: academic component
- Step 2: complementary short-term work-placement alongside academic component (putting knowledge into practice and vice versa)
- Step 3: working in the field – focus on developing competencies through a reflective practice approach
- Step 4: approaching a committee showcasing completed steps (a portfolio) in order to achieve accreditation
- Step 5: ongoing professional development to maintain accreditation

In this way, an accreditation process may encourage individuals with a variety of academic backgrounds and experiences to join, not just those who have a degree in health promotion. Perhaps there can also be levels of professional membership to account for these academic and work-related differences (for example, someone with a masters degree in health promotion may be granted a higher standing); however, I question whether this would just be creating more confusion as to how we define and label ourselves (Practitioner? Specialist? Professional?...does this now become a debate about semantics?). As I give this more thought, I wonder if there’s even a point when a list of competencies and an accreditation process becomes elitist? Wouldn’t creating a visible ‘us’ vs. ‘them’ divide contradict the very nature of health promotion?

[swooley]

Having recently worked on revising standards for accreditation of health education programs in colleges of teacher education in the U.S., I would agree that consideration needs to be given to different levels. College-educated entry-level practitioners could be expected to have knowledge of all competencies, but their opportunities for experience and developing proficiency will be limited. Some level of proficiency in the 3rd - 8th competencies is not unrealistic, but providing leadership and being a catalyst for change require experience and established connections.

There are also health promotion practitioners who are not college educated. Community organizers who work in the area of health promotion might have experience as catalysts for change if they are leaders in a community, but might not have competencies in formal assessment and evaluation.

[brianneeson]

I spoke at the Galway conference
If I didn't mention it, the Health Promotion Managers in Scotland have a template which distinguishes core and advanced competencies
http://www.healthscotland.com/uploads/d ... 130206.pdf

[Larissa Kaminskyj]

The list of competencies in the Galway Consensus Statement and the template from Scotland is quite comprehensive – while we have discussed the possibility of having varying levels of accreditation, do you think it’s also possible that it would be difficult for someone to exhibit all of these competencies? Do you think that there should be a core list of competencies and then additional competencies depending on the type of health promotion work one is engaged in, such as community development, academic research, government policy, etc?

[Maurice Mittelmark]

I think it is important to remember that the Galway statement has to do with domains of competencies, not competencies themselves.... I suggest several pointed questions for discussion:

1. Are there domains other than the eight that should be added?

2. Are there domains that should be deleted?

3. Are there domains that could be clarified by wording changes?

4. Are there places in the world of health promotion where part or all of the statement would not be relevant/appropriate?

I suggest these questions, because in the end the Galway group wants feedback from the field on the adequacy of the work, so we need comments about the Statement (as well as a more general discussion about HP competencies).

[Oguda]

The Galway Statement is an interesting read. I have been going through the domain of competencies and have the following to comment about:

1.There is need to clarify the domains by instituting some changes in the wording. The following comes to mind. ASSESSMENT and EVALUATION may mean the same concept at surface value unless the whole statement is read out and a distiction in meaning is made.

Therefore, in place of ASSESSMENT, there should be an addition of NEEDS so that it reads NEEDS ASSESSMENT. In the same breath, to accompany EVALUATION, the word PROGRAM should precede so that it reads PROGRAM EVALUATION.

2. I have a MONITORING aspect to be added to the list of domains. This suggestion emanates from the idea that for effective programmes to be evaluated, there should be some sequence of follow-ups along the way so that at the mid-line or end-line during the evaluation processes, several lessons can be drawn based on the course that such programmes have taken over the time-line.

3.I am drawn to conclude that the sequence of the domains should be re-drafted in line with the stages that normal programme implementation procedures usually takes. For example, CATALYZING CHANGE can only come after a NEEDS ASSESSMENT has been done, and so on and so forth. This suggestion stems from the realization that there is bound to be potential mix-ups with the underlying meanings of the domains unless a clear line is drawn based on the sequence the process should follow.

4. I am of the opinion that either CATALYZING CHANGE or ADVOCACY should be deleted from the list of domains. I draw my reasoning from the fact that the reason why Health Promotion practitioners employ advocacy campaigns is because they need to initiate change in patterns of Health Care Systems at any level. If this reasoning goes, then there is no necessity to include CATALYZING CHANGE since that is the sole reason why we engage communities in matters concerning improving their Health.

Thanks

Gabriel Oguda