Tremblay Marie-Claude, Richard Lucie
*Corresponding authors. E-mail:
Health Promot Int. 2014 Jun;29(2):378-88. doi: 10.1093/heapro/dar054. Epub 2011 Sep 8.
Health promotion underpins a distancing from narrow, simplifying health approaches associated with the biomedical model. However, it has not yet succeeded in formally establishing its theoretical, epistemological and methodological foundations on a single paradigm. The complexity paradigm, which it has yet to broach head-on, might provide it with a disciplinary matrix in line with its implicit stances and basic values. This article seeks to establish complexity's relevance as a paradigm that can contribute to the development of a health promotion discipline. The relevance of complexity is justified primarily by its matching with several implicit epistemological and methodological/theoretical stances found in the cardinal concepts and principles of health promotion. The transcendence of ontological realism and determinism as well as receptiveness in respect of the reflexivity that complexity encompasses are congruent with the values of social justice, participation, empowerment and the concept of positive health that the field promotes. Moreover, from a methodological and theoretical standpoint, complexity assumes a holistic, contextual and transdisciplinary approach, toward which health promotion is tending through its emphasis on ecology and interdisciplinary action. In a quest to illustrate our position, developmental evaluation is presented as an example of practice stemming from a complexity paradigm that can be useful in the evaluation of health promotion initiatives. In short, we argue that it would be advantageous for health promotion to integrate this paradigm, which would provide it with a formal framework appropriate to its purposes and concerns.
健康促进是与生物医学模式相关的狭隘、简化的健康方法的一种背离。然而，它尚未成功地在单一范式上正式确立其理论、认识论和方法论基础。它尚未正面触及的复杂性范式，可能会为其提供一个与其隐含立场和基本价值观相符的学科矩阵。本文旨在确立复杂性作为一种范式的相关性，这种范式能够促进健康促进学科的发展。复杂性的相关性主要通过它与健康促进的基本概念和原则中发现的几种隐含的认识论和方法论/理论立场相匹配来证明。本体论实在论和决定论的超越，以及对复杂性所包含的反思性的接受，与该领域所倡导的社会正义、参与、赋权和积极健康概念的价值观是一致的。此外，从方法论和理论的角度来看，复杂性采取一种整体的、情境化的和跨学科的方法，而健康促进正通过强调生态学和跨学科行动趋向于这种方法。为了说明我们的立场，发展性评价被作为源于复杂性范式的一种实践示例呈现出来，这种示例在健康促进倡议的评价中可能是有用的。简而言之，我们认为健康促进整合这一范式将是有益的，这将为其提供一个与其目的和关注点相适应的正式框架。
